The Influence of Personality, Soacial Cognition N Environmental Fact

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THE INFLUENCES OF PERSONALITY, SOCIAL COGNITION, AND
ENVIRONMENTAL FACTORS ON PHARMACEUTICAL CARE
by
Tanattha Kittisopee
A thesis submitted in partial fulfillment

of the requirements for the Doctor of
Philosophy degree in Pharmacy
in the Graduate College of
The University of Iowa
July 2001
Thesis supervisor: Associate Professor Bernard A. Sorofman
UMI Number: 3018585
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300 North Zeeb Road
P.O. Box 1346
Ann Arbor, Ml 48106-1346
Copyright by
TANATTHA KITTISOPEE
2001
All Rights Reserved
Graduate College
The University of Iowa
Iowa City, Iowa
CERTIFICATE OF APPROVAL
PH.D. THESIS
This is to certify that the Ph.D. thesis of
Tanattha Kittisopee
has been approved by the Examining Committee

for the thesis requirement for the Doctor of
Philosophy degree ' !0
graduation.
Thesis committee:
Member
Member
Member
For the Memory of My Father
"Hope you can see this success."
ii
ACKNOWLEDGMENTS
It is extremely difficult and probably impossible to

thank all people who I have become indebted to during the
route of my study. It is critical to acknowledge those
persons who stood by me along the way and made immeasurable

contributions. The foremost person I would like to express
my heartfelt gratitude to is Dr. Bernard A. Sorofman who
has served as my academic advisor, my mentor, and finally
my dissertation supervisor, for.his support, guidance, and
patience. Since my arrival at the College of Pharmacy at

the University of Iowa, he has become the most vital part
of my academic development. During my five years in Iowa
he gave generously of his time, talent and positive
encouragement. This has enabled me to attain invaluable
skills from him and kept me going through some of the

darkest days. I am especially grateful for all the
detailed written and oral comments he and Dr. Karen Farris

made about every draft chapter of my thesis, saving me from
several embarrassing errors and providing additional
information.
My sincere gratitude is also expressed to the other
members of my committee: Dr. William R. Doucette; Dr. Julie
Ganther; and Dr. Eva Klohnen for their valuable insights
iii
and knowledge that enabled me to fine-tune and strengthen
my thesis. I would also like to keep count of my
appreciation to Dr. John Brooks for his kindness and
knowledge provided to me during my study; to Lynn V.Borders
and Jeneva Ford for their friendships and assistance in
many ways; to Courtenay Bouvier for her help in correcting
language in my thesis; and to Phil Potter for his help in

formatting my thesis. I must thank the hundreds of people
who responded to my survey; without them my thesis would

not be possible.
I am grateful to Dr. Rungpetch Sakulbumrungsil who
introduced me to the scholarship of the Thai Ministry of
University Affairs for Chulalongkorn University and

encouraged me to pursue the study. Whenever I asked for
help from her, she provided prompt and supportive replies.

I would like to thank Karnchit Punyakanok for taking care
of my family while I was in Iowa. I also owe a number of

thanks to all those who endorsed my contract with the Thai
government for my study abroad: Dr. Chamnan Patarapanich,
Col. Lursak Mahasub, Pol. Lt. Col. Pimol Bumrung, Asst.

Prof. Supinya Kumvorachai, Asst. Prof. Sathitpong
Thanaviriyakul, and Asst. Prof. Wanchai Treyaprasert.

Without them, I would not have been able to come here.
Now, I would like to thank my friends here in Iowa
City: Saovaluck Jirathummakoon and Suwanna Plungpongpan who
iv
have been my strength when I felt weak and my comfort in
hard times and who stepped in when I really, really needed
good friends; Arlene and John Miller who have been always
genial friends; Swalee and Dr. Cheng Saw, Asst. Prof.
Narirat and Aram Jitramontree, and my classmates who have
been sources of joy and help all the time.
Finally, one very special THANK YOU filled with all my

love and appreciation -goes out to my mother, Aow Mokheng,
my sisters, Udomluck and Pakamart Kittisopee, and my

nephew, Vichien Kumpark, for their understanding and
patience to wait for me back home.
My cordial thanks goes out to each of you mentioned

here. May God continue to bless you and your family as you
have blessed and enriched me.
TABLE OF CONTENTS
Page
LIST OF T A B L E S ........................................... viii
LIST OF FIGURES ......................................... xii
CHAPTER
I INTRODUCTION .................................. 1
Significance of the Study ................. 6

II LITERATURE REVIEW ............................ 9
Introduction ............................... 9
Personality................................ 10
Social Cognitions ......................... 26
Behavior Relative to Pharmaceutical Care .. 34
Pharmacy Practice Environment ............. 38
Proposed Mediators of Social Cognition
Between Personality and Behavior
Relative to Pharmaceutical C a r e ...... 41
Proposition Statements .................... 42
Hypothesized Models ....................... 44
III METHODOLOGY................................... 48
Research Design ........................... 48
Study Variables and Measurements 49
Population and Sample ..................... 70
Pretest.................................... 71
Pilot T e s t ................................. 71
Data Co l l e c t i o n ........................... 72
Data Coding and Cleaning.................. 73
Data A n a l y s i s ............................. 73
IV RESULTS....................................... 83
Descriptive Statistics .................... 84
Item Analysis and Scale Reliabilities 94
Correlations Among Variables .............. 94
Multiple Regression Analyses .............. 97
Analysis of Theoretical Model ............. 101
Mediational Analysis ...................... 103
Post Hoc A n a l y s e s ......................... Ill
Summary .................................... 132
vi
V D IS C U S S IO N S .................................................................................................. 136
Over v i e w................................... 136

Contribution of Personality to
Pharmaceutical Care Provision ......... 138
Psychosocial Theoretical Model ............ 146
Direct Determinants of Behavior ........... 150
Behavioral Intention as a Mediator ....... 154
Scientific Implication .................... 156
Practice Implication ...................... 157
Limitation................................. 159
Future Research ............................ 162
Conclusion................................. 165
APPENDIX A. DESCRIPTIVE DATA OF I T E M S .............. 167

APPENDIX B. ITEMS CORRELATION OF EACH MEASURE AND
FACTOR ANALYSIS OF B F I .................. 174
APPENDIX C. QUESTIONNAIRE, LETTERS, CODE B O O K ......... 187
REFERENCES............................................... 210
v ii
LIST OF TABLES
Table Page
1. The Five Factor Definitions and Illustrative
Scales ........ ............................. 18
2. Items for Measuring Extraversion ............... 51
3. Items for Measuring N e u r oticism................ 51
4. Items for Measuring Agreeableness.............. 52

5. Items for Measuring Openness ................... 53
6. Items for Measuring Conscientiousness ......... 54
7. Items of The Patient Assessment Dimension...... 56
8. Items of The Drug-related Problem Resolution
D i m e n s i o n ........................................ 57
9. Items of The Documentation D i m e n s i o n ............ 57

10. Items for Measuring Behavioral Intention ....... 60
11. Items for Measuring Attitude toward
Pharmaceutical Care Provision .................. 62
12. Items for Measuring Subjective N o r m ............ 64
13. Items for Measuring Perceived Behavioral

C o n t r o l .......................................... 66
14. Item and Answer Choices for Measuring the Type
of Practice Setting ............................. 67
15. Item for Measuring W o r k l o a d ..................... 68

16. Items for Measuring the Adequacy of Resources . . 69
17. Pharmacists' Practice Characteristics .......... 85
18. Number of prescriptions, Patients, and Beds of

each S e t t i n g .................................... 86
19. Pharmacist Demographic characteristics ......... 87
v iii
20. Pharmacists' Personality Characteristics
Overall Scores .................................. 88
21. Pharmacists' Personality Characteristics

Compared to Population N o r m .................... 90
22. Social Cognitive and Behavioral Variables
Characteristics ................................. 92
23. Practice Environment Characteristics........... 93
24. Reliability Coefficients for M e a s u r e s .......... 95

25. Pearson Correlation Coefficient Matrixes of
All Study Key V a r i a b l e s ......................... 98
26. Multiple Regression Model Results: Hypothesis

o n e .............................................. 100
27. Multiple Regression Model for Predicting
Behavioral Intention: Hypothesis 2.1 ........... 102
28. Multiple Regression Model for Predicting

Pharmaceutical Care Provision:. Hypothesis 2.2 .. 104
29. Results of Regression Model 1: Mediational
A n a l y s i s ......................................... 107
A n a l y s i s ......................................... 108
A n a l y s i s ......................................... 109
32. Regression Coefficient of Each Personality
Dimension Before and After Including a
M e d i a t o r ......................................... 110
33. Multiple Regression Model Results from Post

Hoc Analysis (Model for Predicting
Pharmaceutical Care Provision) ................. 112
34. Regression Coefficients of Stepwise Model:
Post Hoc A n a l y s i s ............................... 113
35. Summary of The Full Model with Pharmacist

Demographics .................................... 115
36. Regression Coefficients of Variables in The

Full Model with Pharmacist Demographics ........ 116
ix
Analysis (Post Hoc Analysis) .................... 119
40. Regression Coefficient of Each Personality
Mediator (Post Hoc Analysis) .................... 122
41. Post Hoc Multiple Regression Model Results:

Hypothesis one (Adding Pharmacist Demographics
as control variables) .......................... 124
42. Post Hoc Multiple Regression Model for

Predicting Behavioral Intention (Adding
Pharmacist Demographics as control variables
in the Model for predicting Intention) ........ 125
43. Post Hoc Multiple Regression Model for

Predicting Pharmaceutical Care Provision
(Adding Pharmacist Demographics as control
variables) ...................................... 127

Analysis (Adding Pharmacist Demographics as
control variables) .............................. 128

47. Descriptive Statistics for Individual Items of
the Personality Measure (BFI) (Scale 1-5:
Strongly Disagree-Strongly Agree) .............. 168
the Attitude toward Pharmaceutical Care
Measure (Item Scale 1-7: Extremely
Unfavorable- Extremely Favorable) .............. 170

the Subjective Norm Measure (Item Scale 1-7:
Extremely Disagree- Extremely Agree) .......... 170
the Perceived Behavioral Control Measure (Item
Scale 1-7: Extremely Difficult-Extremely Easy) . 171
the Behavioral Intention Measure (Item Scale
1-7: Extremely Unlikely-Extremely Likely) ..... 171
the Pharmaceutical Care Provision Measure
(Scale 0-5) ...................................... 172
the Adequacy of Resources Measure3 and Adequacy
of Resources Variable13.......................... 173
54. Inter-item Correlations for Extraversion

Measure and Extraversion Variable .............. 175
55. Inter-item Correlations for Agreeableness
Measure and Agreeableness Variable ............ 17 6
56. Inter-item Correlations for Conscientiousness
Measure and Conscientiousness Variable ........ 177
57. Inter-item Correlations.for Neuroticism

Measure and Neuroticism Variable .............. 178
58. Inter-item Correlations for Openness Measure
and Openness Variable ........................... 17 9
59. Inter-item Correlations for the Attitude
toward Pharmaceutical Care Measure and
Attitude Variable ............................... 180
60. Inter-item Correlations for the Subjective
Norm Measure and Subjective Norm Variable ..... 180
61. Inter-item Correlations for the Perceived
Behavioral Control Measure and Perceived
Behavioral Control Variable .................... 181
62. Inter-item Correlations for the Behavioral
Intention Measure and Behavioral Intention
V a r i a b l e ......................................... 181
63. Inter-item Correlations for the Pharmaceutical
Care Provision Measure and Pharmaceutical Care
Provision V a r i a b l e ................. 182
xi
64. Inter-item Correlations for the Adequacy of
Resources Measure and Adequacy of Resources
V a r i a b l e ......................................... 184
65. Structure Matrix from Factor Analysis Result
of B F I ........................................... 185
x ii
LIST OF FIGURES
Figure Page
1. The Hypothesized Model for Research Question 1 - 44

2. The First Hypothesized Model for Research
Question 2 ...................................... 45
3. The Second Hypothesized Model for Research

Question 2 ...................................... 46
4. The Hypothesized Model for Research Question 3 . 47
5. An Example of Specific Phrases and Adjectives

for Behavioral Intention Suggested by Ajzen and
Fishbein (1980) ................................. 58
6. An Example of Attitude Measure Suggested by

Ajzen and Fishbein (1980)....................... 61
7. An Example of Subjective Norm Measure Suggested

by Ajzen and Fishbein (1980) ................... 63
8. General Mediational Model ....................... 81
9. Personality Profile of Pharmacists Compared to

the Population N o r m ............................. 89
10. Results Diagram of Hypothesis 3 ................. 110
11. Diagram Results of Mediational effect of
Intention Between Openness and Pharmaceutical
Care Provision (Does Not Control for Perceived
Behavioral Control) ............................. 122
12. Graphical Result of the Current Study .......... 135
1
CHAPTER I
INTRODUCTION
Pharmacists are expected to perform new activities as

their patient care role evolves. Pharmaceutical care is
direct patient care and involves the process through which a
pharmacist joins with a patient and other professionals in

designing, implementing, and monitoring a therapeutic plan
that will produce specific therapeutic outcomes for
patients. Even though pharmaceutical care is not the whole

picture of pharmacy practice, the future direction of the
profession is to adopt a practice philosophy of direct
patient care like pharmaceutical care. Yet, the adoption of

pharmaceutical care activities into the practice is still
minimal (Kittisopee, Sorofman and Doucette, 2000). Some
pharmacists promptly adopt pharmaceutical care activities,
some may adopt these activities after a period of

consideration, and some may never adopt pharmaceutical care
activities into their practice. It is not known what

determinants lead a pharmacist to perform pharmaceutical
care.
The past remarkable research (Farris, Kirking, 1995;
Odedina et. al., 1997) focused only on social cognition

models to consider the determinants that lead pharmacists to
2
provide pharmaceutical care, but it is also important to

consider personality as well as environment. Psychological
theory indicates that human behavior is determined by an
individual's personality traits (Ornstein, Markert, Johnson,
Rust, and Afrin, 1988). Personality constructs deserve
special consideration when attempting to predict individual
differences in behaviors. Pharmacists may be reluctant to
change the way they practice because they are uncomfortable
doing some of the newer practice activities. This is not
because they cannot learn them, but because of their
personality preferences. Therefore, it is likely that the

pharmacist's personality traits will predict his behavior
relative to pharmaceutical care.
At the individual level, a pharmacist's personality and

his social cognitions are the inherent factors that can
affect the decision to adopt pharmaceutical care activities

into his practice (Nimmo and Holland, 1999d; Farris and
Schopflocher, 1999; Rovers, Currie, Hagel, McDonough, and
Sobotka, 1998; Campagna and Newlin, 1997). Thus, there is a
need to understand those determinants of behavioral change
relative to pharmaceutical care at the individual level,

including the pharmacist's personality and his social
cognitions.
In order to facilitate the provision of pharmaceutical
care, however, practice environments such as practice
3
setting, adequacy of resources, and workload should be

conducive for pharmacists to perform pharmaceutical care
activities. The personality and social cognitions of

pharmacists and their practice environments might
simultaneously affect the way they choose to perform this

new practice and, consequently, influence their provision of
pharmaceutical care. Therefore, the overall purpose of the
present study was to investigate the important roles of
pharmacists' personality and their social cognitions on

pharmaceutical care provision, and the link among
personality, social cognitions, and behavior after
accounting for environmental factors.
The first specific objective of this study was to
investigate the role of personality on behavior, controlling
for environmental factors. This presents an interesting

practice-based research question:
R Q 1 : Does the personality of a pharmacist

significantly contribute to the explanation of
behavior relative to pharmaceutical care,
controlling for the practice environments?
Personality factors appear to make a significant
contribution to predicting behavior, but several factors may

be missing, accounting for low explanatory power in previous
studies. Social-cognition can be a factor that also

influences behaviors (Anderson, Winett, and Wojcik, 2000;
Booth, Owen, Bauman, Clavisi, and Leslie, 2000; Hillhouse,
Turrisi, Kastner, 2000; Schwarzer and Renner, 2000; Evans,
4
Christiansen and Gill, 1996; Granrose and Kaplan, 1994).

Attitudes on the practice behavior of pharmacists have been
considered as a major factor influencing decision-making
about what is appropriate to do (Campagna and Newlin, 1997;

Rovers, Currie, Hagel, McDonough, and Sobotka, 1998; Hansen
and Ranelli, 1994; Fjortoft and Lee, 1994; Kirking, 1984;
Knapp, 1979). The role that attitudes play in behavior
relative to pharmacy practice can be obtained by examining
the Theory of Planned Behavior. Extensive research has been
conducted on behavior relative to pharmaceutical care using

the social cognition concepts found in the Theory of Planned
Behavior (Odedina, Hepler, Segal and Miller, 1997; Odedina,

Segal, Hepler, Lipowski, and Kimberlin, 1996; Farris and
Kirking, 1995). However, those studies focused on only the
influences of pharmacists' social cognitions, and did not

include the personality of pharmacists.
To date, there is no research on personality combined
with social cognitions to predict behavior relative to
pharmaceutical care, controlling for the practice

environment. The second specific objective of the current
study tested a theoretical model that integrated personality

and social cognitions to predict behavior. Thus, the second
research question of this study was:
R Q 2 : What variables among the basic structures of

personality and social cognitions will directly
determine pharmacists' intention and self-reported
5
behavior relative to pharmaceutical care,

controlling for the practice environment?
When pharmacists are being encouraged to adopt a new
practice that may be not compatible with their personality,
conflict may occur and ultimately result in slow adoption of
the new practice. It may not be easy to change
personalities, but their social cognitions can be changed by

the influences of their environments and people around them,
or by the process of professional socialization. Therefore,
there is a possibility that personality influences behavior
directly or indirectly through social cognition. It is also

not known to what extent the relation between personality of
pharmacists and their behavior in the provision of
pharmaceutical care is mediated by social cognition. The
third specific objective of the present study, therefore,

was to investigate whether social cognition can mediate
between personality and behavior. The third research

question of this study was:
R Q 3 : Do the social-cognitive constructs

significantly mediate the relationship between
personality and behavior, controlling for the
practice environments?
In conclusion, this study had three objectives: 1) to
investigate the pharmacists' personality in predicting
pharmacists' behavior relative to pharmaceutical care,

controlling for practice environment; 2) to test a
theoretical model that integrates personality and social
cognitions to predict behavior; and 3) to examine the
6
mediational effects of social cognition that links the basic

personality structures to behavior.
Significance of The Study

This study linked personality concepts, social-
cognition concepts, and practice environmental factors with
professional behavior. The results from this study will
contribute to the science of personality psychology, social

psychology, and pharmacy. These data add to the literature
in these areas and contribute to understanding the impact of
mixed results of personality, social-cognition, and
environment on professional behaviors.
The context of pharmacy was chosen to investigate the
link of personality concepts, social-cognition concepts, and
environmental factors with professional behavior. From the

aims of this study, this study yielded an opportunity to
examine the relation between pharmacists' personality and
their behavior relative to pharmaceutical care provision in

the context of their social cognitions and practice
environment. This study, therefore, directly applies to the
profession of pharmacy, especially to the new philosophy of
the practice, "pharmaceutical care" (Hepler and Strand,

1990.
A given work setting and activity may fit with the
personalities of specific persons to varying degrees
(Greenberg and Baron, 1996). Some persons may find that
7
their traits closely match those required by a given job.

The match between a person's personality traits and the
demand of the job's activities can bring motivation and
satisfaction in those job's activities and increase
productivity. The behaviors comprising pharmaceutical care

may match a certain personality type of pharmacists. The
results of this study can be applied to pharmacy practice in
the sense that personality may need to be taken into account
when developing and administering interventions to encourage
pharmacists to provide pharmaceutical care. Knowing the

association between personality traits and pharmacists'
behavior relative to pharmaceutical care may allow employers
to identify the appropriate personality for a pharmacist for

placement in work position on the basis of this match with
their personality profile. The use of personality inventory
instrument in this study provides an objective measure.
This study advocated multivariate approaches to

research by examining relations of behavior to individuals'
personality patterns or profiles in addition to examining
simpler bivariate relations. Using multiple indicators of
constructs in this study allowed for more accurate modeling.
Data from the present study can contribute to the literature
supporting the important role of personality and social
cognition factor in behavior. It specifically adds to
literature that combined the Five-Factor Model and the
8
Theory of Planned Behavior to predict behaviors (Courneya,

Bobick, Schinke, 1999; Autrey, 1999).
9
CHAPTER II
LITERATURE REVIEW
Introduction
Theory-driven studies in the area of pharmacy practice
still appear limited. The pharmacy practice literature has
used at least two theoretical approaches in consideration of
pharmacy practice behavior changes. Most of them used
social-cognition theories as a framework to explain,
predict, and generalize the relationships between social-

cognition constructs and the practice behaviors (Farris and
Schopflocher, 1999; Odedina, Hepler, Segal and Miller, 1997;
Berger and Grimley, 1997). The personality of pharmacists
has not been explored as a factor in the behavior exhibited
in pharmaceutical care provision. There is also no research

on the mediator effect of social-cognition between
personality and behavior in the area of pharmaceutical care.
The present study investigated the link between personality

and social-cognition with behaviors, controlling for the
practice environments.
This chapter presents the literature review of concepts
relevant to the study's objectives. The first section is a

brief explanation of personality and its association with
10
behavior; the Five Factor Model of personality, which is the

personality framework in this study, and its association
with work-related behavior; and previous research on
personality in the area of pharmacy. The second section
presents social cognition concepts, the Theory of Planned
Behavior, the social cognition framework in this study, and
previous research using the Theory of Planned Behavior to
study pharmacists' behavior relative to pharmaceutical care.
The third section discusses a pharmaceutical care model and

behavior relative to pharmaceutical care. The fourth
section presents pharmacy practice environments, which are
the controlling variables used in this study. The fifth and

last section provides proposition statements for the present
study.
Personality
Within psychology, personality is a complex topic and
the definitions of personality have various themes based on

the different perspectives (Furnham and Heaven, 1999). The
way personality psychologists have defined personality has
changed over the years (Carducci, 1998) . This is further
complicated by the fact that personality has been
conceptualized from a variety of theoretical perspectives,
and at various levels of abstraction or breadth (John and
Srivastava, 1999), making it quite an elusive concept. Many

definitions have been offered (Pervin and John, 1997;
11
Funder, 1997; Pervin, 1996; Walter, 1981; Me Clelland, 1951;

Cattell, 1950; Allport, 1937), but none of them are
universally accepted (Carver and Scheier, 2000) . However,
personality appears to convey the sense that there is a
consistency within the person, a causal force within the
person influencing how the person acts, and a few salient

characteristics that can serve as a summary for what a
person is like (Carver and Scheier, 2000).
There are many ways or perspectives of thinking about

personality. The assumption of the dispositional
perspective best fits the objectives of the current study.
The dispositional perspective is based on the idea that
people have relatively stable qualities or dispositions that
are displayed in diverse settings and differ from each other

in many ways. Thus, the personality is made up of certain
definite disposition attributes or traits (Mischell, 1968).
Most important, it is widely assumed that traits are

relatively stable and enduring predispositions that exert
fairly generalized effects on behavior (Sanford, 1963;
Allport, 1966). Since traits are fundamental building

blocks of human personality and are relatively stable,
traits may influence the way humans behave. The present
study investigated whether traits affect professional
behavior.
12
Personality and Behavior

To ensure a scientific foundation, this study first
integrated the theoretical constructs of personality and
behavior. Behavior arises from inside the person and there
is a causal force within the person influencing how the
person acts, according to personality theory. Many

psychological theorists also indicate that human behavior is
determined by an individual's personality traits (Ornstein,
Markert, Johnson, Rust, and Afrin, 1988). Empirical
research has been conducted to investigate the relationship
between personality and human behaviors. Most researchers

used personality traits to predict behaviors and individual
differences in behavior. There is a large volume of

scientific evidence that personality traits are related to
human behavior. Example of behaviors that have been studied
in relation to personality include health behavior (Johnson,
2000; Ingledew and Stuart, 1999; Jerram, and Coleman, 1999;
Courneya and Hellsten, 1998; Booth-Kewley and Vickers, 1994;

Dielman, Leech, Miller, and Moss, 1991; Savage and
Marchington, 1977), consumer behavior (Mooradian and Olver,

1996), human performance and learning (Mumford, Baughman,
Threlfall, and Uhlman, 1993), job-search behavior (Lay and
Brokenshire, 1997), driving accident involvement (Arthur and
Graziano, 1996), employee self-directed behavior (Stewart,
13
Carson, Cardy, 1996), retention (Shenk, Watson, and Hazel,

1973) and interviewees' success (Caldwell and Burger, 1998).
One of the current, predominant frameworks of
personality is the Five Factor Model. The Five Factor Model
appears to hold great promise for investigations of
correlation between personality and various behaviors
because of its robustness and parsimony. Empirical studies
using the Five Factor Model have focused on the role of
personality on coping response (O'Brien and DeLongis, 1996),

job performance (Barrick and Mount, 1991), creativity
(Furnham, 1999), health behavior (Booth-Kewley and Vickers,

1994) and educational streaming and achievement (Fruyt and
Mervielde, 1996). The current study used the Five Factor
Model of personality as a personality framework to study
pharmacists' care behaviors.
The Five-Factor Model of Personality
In the personality literature, trait theorists agree

that variant traits can be linked to produce a small number
of higher-order traits. The Five-Factor Model has emerged
as an important taxonomy of global personality traits. It
has received increased attention and collaboration for
nearly fifteen years. The consensus within trait psychology

is that the basic structure of personality may consist of
five superordinate factors, which are frequently referred to

as the "Big Five" or the Five-Factor Model (Goldberg, 1981;
14
Wiggins, 1996; McCrae and John, 1992; Digman, 1990; McCrae

and Costa, 1987; Mount and Barrick, 1998; Block, 1995;
Fiske, 1994; Capra and Perugini, 1994; Borkenau and
Ostendorf, 1998) . A five-factor conceptualization has been
found repeatedly in studies that were conducted by different
researchers in a variety of data sources, samples, and
measurements (Bernardin, Cooke and Villanova, 2000; Dalton

and Wilson, 2000; Ghaderi and Scott, 2000; Gullone and
Moore, 2000; Johnson, 2000; De Fruyt and Mervielde, 1999;
Nemechek and Olson, 1999; Ones and Viswesvaran, 1999;
Piedmont, Hill, and Blanco, 1999; Velting, 1999; Wright,

1999; Pervin and John, 1996).
The historical path to the Five-Factor Model evolved
from Allport and Obbert (1936) who abstracted personality

terms from a dictionary. Cattell (1946) then formed synonym
clusters and created rating scales contrasting groups of
adjectives. Tupes and Christal (1961) rated and factored
the 35 scales. Finally, Norman (1963) replicated the best
rating scales from the Tupes and Christal study. However,

for nearly two decades, the consensus that has been emerging
in the 1960s on the five factors was lost. A controversy
over implicit personality theory contributed to the
discouragement of personality psychology in the 1970s, and
the Five-Factor model was rejected for a period of time. But

new studies revived the Five-Factor Model. The most
15
significant new studies were the cross-cultural replication
by Bond (1979), re-analyses of earlier data sets by Digman

and Takemoto-Chock (1981) and the analyses of Goldberg
(1981) which revived interest in the lexical approach and
reintroduced the Five-Factor Model to the mainstream of
personality psychology (McCrae and John, 1992).
A considerable amount of research over several decades
indicates that these five superordinate constructs — which
are Extraversion, Neuroticism, Agreeableness, Openness to
Experience, and Conscientiousness — provide an adequate
taxonomy of personality traits (Digman, 1990; McCrae and

John, 1992; Smith and Williams, 1992; John, 1990). There is
a great deal of commonality in the traits that define each
factor, even though the name attached to the factors

differs.
Extraversion, the first factor, implies an energetic
approach to the social and material world. The traits
frequently related with it include being sociable,

gregarious, assertive, talkative, active, and emotionally
positive (Barrick and Mount, 1991; John and Srivastava,
1999).
The second factor has been labeled with many names such
as Emotional Stability, Stability, Emotionality, or
Neuroticism. Neuroticism, as it was labeled in this study,
contrasts emotional stability and even-temperedness with
16
negative emotionality. The common traits related with it

include being anxious, depressed, angry, embarrassed,
emotional, worried, sad, tense, and insecure (Barrick and

Mount, 1991; John and Srivastava, 1999).
The third factor has been called Intellect,
Intellection, Openness, Openness to Experience, or Culture.
Openness, as it was labeled in this study, describes the
breadth, depth, originality and complexity of an

individual's mental and experiential life. The traits
related with this last dimension include being imaginative,
cultured, curious, original, broad-minded, intelligent, and
artistically sensitive (Barrick and Mount, 1991; John and
Srivastava, 1999) .
The fourth factor has been labeled as Agreeableness,
Likeability, Friendliness, Social Conformity, Compliance

versus Hostile Non-Compliance, or Love. Agreeableness, as
it was labeled in this study, assesses the attitudes an

individual holds toward other people. The traits related
with it include being altruistic, courteous, flexible,
trusting, good-natured, cooperative, forgiving, soft
hearted, modest and tolerant (Barrick and Mount, 1991; John
and Srivastava, 1999).

The last factor, Conscientiousness, has also been
labeled Conformity, Dependability, Will to Achieve, Will, or
Work. Conscientiousness, as it was labeled in this study,
17
describes socially prescribed impulse control that

facilitates task- and goal-directed behavior, such as
thinking before acting, delaying gratification, following

norms and rules, and planning, organizing, and prioritizing
tasks. The traits related with this dimension include being
careful, thorough, responsible, organized, planful,

hardworking, achievement-oriented, and persevering (Barrick
and Mount, 1991; John and Srivastava, 1999).
To visibly demonstrate the meaning of factors, Table 1
presents a number of trait adjectives that describe
individuals scoring high and low on each factor. The
definitions of factors in Table 1 are based upon the work by
Costa and McCrae (1985). The definitions proposed by other
researchers are quite similar.
Five-Factor Model of Personality
and Work-related Behavior
The Five-Factor Model, or its three-factor predecessor
(Neuroticism, Extraversion, and Openness: NEO), has been
found to be related to work issues, the focus of this study.

For example, leadership is related to four general domains
of personality, which are neuroticism, extraversion,
agreeableness, and conscientiousness (Vickers, 1995).

Studies show that the Five Factor Model of personality is
related to work behavior and work attitude including job
18
Table 1. The Five Factor Definitions and Illustrative

Scales
Characteristics of Trait Scales Characteristics of

the High Score the Low Score
EXTRAVERSION
Sociable, active, Assesses quantity and intensity of Reserved, sober,

talkative, person- interpersonal interaction; activity level; unexuberant, aloof,
oriented, optimistic, need for stimulation; and capacity for task-oriented,
fun-loving, joy. retiring, quiet
affectionate
NEUROTICISM
Worrying, nervous, Assesses adjustment vs emotional Calm, relaxed,

emotional, insecure, instability. Identified individuals prone unemotional, hardy,
inadequate, to psychological distress, unrealistic secure, self-
hypochondriacal ideas, excessive cravings or urges, and satisfied
maladaptive coping response
OPENNESS
Curious, broad Assesses proactive seeking and Conventional, down-

interests, creative, appreciation of experience for its own to-earth, narrow
original, sake; toleration for and exploration of interests,
imaginative, unfamiliar unartistic,
untraditional unanalytical
AGREEABLENESS
Soft-hearted, good- Assesses the quality of one's Cynical, rude,

natured, trusting, interpersonal orientation along a suspicious,
helpful, forgiving, continuum from compassion to antagonism in uncooperative,
gullible, thoughts, feeling, and actions vengeful, ruthless,
straightforward irritable,
manipulative
CONSCIENTIOUSNESS
Organized, reliable, Assesses the individual’s degree of Aimless, unreliable,

hardworking, self- organization, persistence, and motivation lazy, careless, lax,
disciplined, in goal-directed behavior. Contrasts negligent, weak-
punctual, scrupulous, dependable, fastidious people with those willed, hedonistic
neat, ambitious, who are lackadaisical and sloppy
persevering
Source: Pervin, L.A. John, O.P. (1996). Personality: Theory and Research 7ch edition. P
259
19
performance (Barrick and Mount, 1991; Tett et al., 1991;

Salgado, Rumbo, 1997), job satisfaction (Robertson,
Callinan, 1998), choice related process, job search, career
progression and changes, career commitment and occupational
stress, strain, and burnout (Tokar, Fischer, Subich, 1998).
The relation between personality and job performance,
however, can be moderated by type of work performed
(Heckman, 1999), ability (Mount, Barrick, Strauss, 1999),
accountability (Frink and Ferris, 1999), performance
monitoring (Robie and Ryan, 1999), and job autonomy (Slimak,

1997).
Conscientiousness, one of the personality dimensions in
the Five Factor Model, was most consistently related to
performance across jobs (Barrick and Mount, 1991; Tett et
al., 1991; Salgado, 1997). As addressed above,
conscientiousness appears to have three related elements,

which are achievement orientation, dependability, and
orderliness. One who scores high in conscientiousness,
therefore, tends to be hardworking, persistent, responsible,
careful, planful and organized. It is not surprising that
this personality dimension is a valid predictor of success
at work. Recent empirical evidence supports the importance

of conscientiousness at work, linking this dimension to work
dedication (Hogan, Rybicki, Motowidlo, and Borman, 1998),
job performance (Dalton and Wilson, 2000; Stewart, 1999;
20
Mount, Barrick, Strauss, 1999; Miller, Griffin, and Hart,

1999; Frink and Ferris, 1999; Robie and Ryan, 1999; Vinchur,
Schippmann, Switzer, and Roth, 1998; Mount, Barrick and
Stewart, 1998; Salgado, 1997; Piedmont and Weinstein, 1994;

Barrick and Mount, 1991; Tett et al., 1991),
counterproductive work behavior (Hogan and Ones, 1997),

attendance at work (Judge, Martocchio and Thoresen, 1997),
customer services (Furnham and Coveney, 1996), and effective
job seeking behavior (Wanberg, Watt and Rumsey, 1996).
Extraversion, typically, tends to encompass socially
oriented characteristics such as being outgoing and
friendly, but also includes traits such as dominant,

aspiring, active, adventurous and assertive. Extraverts are
more likely to take on leadership roles (Watson and Clark,
1997) and to prefer frequent interaction with others

(Satava, 1997). It is, therefore, not surprising that
extraversion has a positive correlation with sales
performance (Stewart, 1996) and customer services (Furnham
and Coveney, 1996). Many studies showed that job
satisfaction is associated with extraversion (Francis and
Robbins, 1999; Sah and Ojha, 1989; Mohan and Bali, 1988;
Guha, 1965; Anand, 1977). There is also a positive

relationship between extraversion and job performance
(Cutchin, 1999; Furnham, Jackson, and Miller, 1999; Vinchur,
21
Schippmann, Switzer, Roth, 1998; Stewart, 1996; Piedmont and

Weinstein, 1994; Barrick and Mount, 1993).
Neuroticism influences at least two related
inclinations, which are anxiety and one's well-being.
Highly neurotic people tend to be stress prone, unstable,
personally insecure and depressed. It, therefore, refers to
a lack of positive psychological adjustment and emotional
stability. Emotional stability or low neuroticism was

positively correlated with compensation earned (Tull, 1998).
There was an inverse relation between neuroticism and job
satisfaction (Tanoff, 1999; Francis and Robbins, 1999; Sah

and Ojha, 1989; Anand, 1977; Guha, 1965), customer service
(Furnham and Coveney, 1996), job performance (Piedmont and
Weinstein, 1994) and teacher performance (Cutchin, 1999).

Thus, neuroticism tends to inhibit rather than facilitate
work performance.
Agreeableness appears to have two related aspects,

which are being cooperative and likeable. Agreeable people
are trusting of others, caring, good-natured, cheerful, and
gentle. It seems possible that these traits are related to

career success. The cooperative nature of agreeable
individuals may lead to more successful careers,
particularly in occupations where teamwork or customer

service is relevant. Agreeableness was associated with the
ability to accomplish work-related goals and to adapt to
22
changing work condition (Piedmont and Weinstein, 1994) .

Agreeableness was positively related to job performance
(Dalton and Wilson, 2000), job satisfaction (Tanoff, 1999),
interpersonal effectiveness or motive to get along with
others (Conway, 2000), organizational citizenship behavior
(Neuman and Kickul, 1998), job performance involving

interpersonal interactions (Mount, Barrick and Stewart,
1998), customer service (Hurley, 1998), and burnout reports
(Mills and Huebner, 1998).
Openness is characterized by intellect and
unconventionality. People who have a high score on
openness, therefore, are philosophical, intellectual,

imaginative, autonomous, and nonconforming. The
flexibility, creativity, and intellectual orientation of

individuals who exhibit openness may be instrumental to
success in many occupations. Openness leads to the

development of increased job decision latitude (Fried,
Hollenbeck, Slowick, Tiegs, and Ben-David, 1999). Openness
was thought to relate more to training than to performance

(Furnham and Heaven, 1999).
These five basic structures of personality have an
association with behavior related to work. These five basic

structures of personality can be used to predict
pharmaceutical care provision. Pharmaceutical care involves
the process through which a pharmacist joins together with a
23
patient and other professionals in designing, implementing,

and monitoring a therapeutic plan that will produce specific
therapeutic outcomes for patients. Based on the
characteristics of pharmaceutical care activities,
extraversion, agreeableness, conscientiousness and openness
will be predicted to have positive associations with

behavior relative to pharmaceutical care, and neuroticism
will be predicted to have a negative association with
behavior relative to pharmaceutical care in this study.
Prior to this research, no study has investigated how these
basic structures of personality in practicing pharmacists
contribute to work-related behavior relative to

pharmaceutical care.
Previous Research on Personality
in Pharmacy Area
The concept of personality has been used in pharmacy
education (Cocolas and Sleath, 2000; Shuck and Phillips,
1999; Cocolas, Sleath and Hanson-Divers, 1997; Lowenthal,
1994; Draugalis and Bootman, 198 6; Rezler, Manasse and
Buckley, 1977; Rezler, Mrtek and Manasse Jr., 1976). Most
researchers have assessed personality preference in pharmacy
students for the purposes of comparing personality
preferences between pharmacy students and practitioners,
among different professional students and among career
choices. Professions appear to attract students with a
24
personality preference compatible with the tasks required

(Silberman, Cain and Mahan, 1982). Certain work settings in
pharmacy also attract pharmacists with a definable
personality set (Rezler, Mrtek, and Manasse, 1975). Rezler
et al. found the link between personality types and chosen
career pathways in pharmacy. Two career goals, hospital
pharmacy and research in industry, were seen to be affected
most by personality — extraversion-introversion, sensing-
intuition, thinking-feeling, and judging-perception — in

that introvert and judging males chose hospital pharmacy
more often than extravert and perceptive males (Rezler,
Mrtek, and Manasse, 1975).

Draugalis and Bootman (1986) found that the various
tracking approaches to curricular differentiation in
pharmacy, which are clinical, management, and research,
appeal to the distinct Jungian psychological personality
types of pharmacy students. Introverts were more likely to

select research, while management types were more
extraverted. Students selecting the research option were
more intuitive, rather than sensing; and the clinical group
was more feeling than management and research groups.
Lowenthal (1994) showed that personality differences do
exist between practitioners and students in pharmacy.

Individual differences within the practitioners also are
found. Active pharmacists (defined as pharmacists who
25
applied to an external PharmD program, were preceptors for

pharmacy schools, or were elected to pharmacy -related
organizations) have higher scores on ascendancy,
sociability, and original thinking than those who are not in
any of the above-indicated categories (Cocolas, Sleath, and

Hanson-Divers, 1997). Pharmacists cited for violating
pharmacy board regulations had some personality traits -
vigor, ascendancy, original thinking — different from
general pharmacists and pharmacy leaders (Cocolas and
Sleath, 2000).
Individuals tend to seek professional opportunities
that best express their personality preferences and are
interesting and challenging. Personality traits correlate

with career pathways in pharmacy. No study, however, has
investigated how personality can predict work behavior in
pharmacy. Based on this research concerning personality in
pharmacy, it is likely that the personality of pharmacists
will affect the way they choose to perform new practice
behavior and consequently, influence their provision of

pharmaceutical care. This supports the significance of
investigating how the basic structures of personality can
contribute to explain pharmacist's behavior relative to
26
Social Cognitions
Social cognitive theories emphasize the social origins
of behavior and the importance of cognitive thought
processes in all aspects of human behavior. Individuals
process information about the stimuli in the environment
through a set of cognitive functions within the individual

which help in the perception and evaluation of the
environment and the direction of behavior. Social cognition
processes can change because of influences of the situation

or stimuli around an individual, which then affect
individual behavior. The present study combined social
cognitions with personality to explain behavior.
Social cognitive theories propose that behaviors are
the result of behavioral intentions. Ajzen and Fishbein

suggest that when people are deciding whether to do
something, they consider several kinds of information to
form their social cognitions. The outcome information and
its desirability combine to form an attitude about the
behavior. Two other kinds of information relate to the

act's social meaning to the individual. One is whether
people who are important to the individual want him to do
the act. The other is how much he wants to please that
important person. What the other people he is thinking
about want him to do and how much that matters to him
combine to form a subjective norm about the action. If the
27
attitude and subjective norm both favor the behavior, the

individual will form a strong intention to do it (Ajzen and
Fishbein, 1980).
In explaining the behavior relative to pharmaceutical

care, behavioral intention should also play a critical role
because those behaviors are not instinctual or automatic.
Therefore, the present study merges social cognition
concepts with personality to predict behavior relative to

pharmaceutical care. Attitude, subjective norm, and
intention were used as social cognition concepts in this

study. Since behaviors relative to pharmaceutical care are
highly voluntary, the perceived behavioral control was added
to explain behavior (Ajzen, 1985). The Theory of Planned
Behavior (Ajzen, 1985), therefore, was chosen to be a
framework in the present study.
Numerous studies have used the Theory of Planned
Behavior to predict and explain specific behavior of health

care providers. Behaviors include nurses1 administering
morphine for post-operative pain (Jurgens, 1998); predicting
physicians' delivery of preventive services (Millstein,

1996); pharmacists' implementation of pharmaceutical care
(Odedina et al., 1997); and pharmacists' provision of
pharmaceutical care in community pharmacies (Farris &
Schopflocher, 1999). A meta-analysis by Sheppard et al

provides strong support for the overall predictive utility
28
of Fishbein & Ajzen's Theory of Reasoned Action, the origin
of the Theory of Planned Behavior (Sheppard, Hartwick and

Warshaw, 1988). Because of the predictability of the Theory
of Planned Behavior, this theory was used as a framework for

social cognitions in the present study.
The Theory of Planned Behavior
The Theory of Planned Behavior is an extension of the

Theory of Reasoned Action (Fishbein, Ajzen, 1975).
According to Ajzen, the major goal of the Theory of Planned
Behavior is to predict and explain an individual's behavior
(Ajzen, 1985) . In this theory, the determinants of a
behavior are the individual's intention to perform (or not
to perform) that behavior, and perceived behavioral control.
Behavioral intention has been defined by Fishbein and Aj zen

as the individual's subjective probability that he or she
will engage in that behavior (Fishbein & Ajzen, 1975). The
stronger the intention to perform a behavior, the greater
the likelihood that the individual will engage in the
behavior. Behavioral intention is pictured as a function of
three basic determinants, which are attitude toward
performing the behavior, subjective norms, and perceived
behavioral control. The relative weight of these three
components is expected to vary with the kind of behavior
that is being predicted and with the conditions under which
the behavior is to be performed (Ajzen and Fishbein, 1980).
29
Attitude toward performing the behavior is defined by

Fishbein and Ajzen as a person's general feeling of
favorableness or unfavorableness about performing that
behavior (Fishbein & Ajzen, 1975; Ajzen, 1987). The Theory
predicts that the more favorably an individual evaluates

performing a particular behavior, the more likely he or she
will intend to perform that behavior.
Subjective norm is a person's beliefs about whether
people who are important to him do or do not want him to
perform the behavior. It also refers to the perceived
social pressure to perform or not to perform the behavior,
and is weighed by the person's motivation to comply with

those referent individuals. Therefore, a person who
believes that certain referents think he should perform a
behavior, and who is motivated to meet the expectations of

those referents, will hold a positive subjective norm. The
Theory of Planned Behavior predicts that the more an
individual perceives that important others think he should
engage in the behavior, the more likely the person will be

to do that behavior (Fishbein & Ajzen, 1975).
For behaviors that are not completely under one's
volitional control, perceived behavioral control is
critical. Perceived behavioral control is defined as the
individual's beliefs about his or her ability to perform the
behavior and perceived ease or difficulty of performing the
30
behavior. It is assumed to reflect past experience as well
as anticipated impediments and obstacles (Ajzen, 1987). The

Theory of Planned Behavior predicts that the greater the
perceived behavioral control, the stronger should be an

individual's intention to perform the behavior in question
(Ajzen, 1985). The Theory of Planned Behavior suggests that
attitude toward behavior, subjective norm, and perceived
behavioral control are the main antecedents of intention.
It also suggests that perceived behavioral control has a

direct effect on behavior independent of behavioral
intention.
The Theory of Planned Behavior proposes that intention
has a direct effect on behavior, and personality also has a
direct effect on behavior. Therefore, the present study

used this theory combined with personality traits to predict
the pharmacist's behavior relative to pharmaceutical care.
Previous Research on Behavior Relative

to Pharmaceutical Care
and the Theory of Planned Behavior
Few studies have examined the pharmacist's behavior

using a theoretical model. Two exceptions used the Theory
of Planned Behavior or its precursor, the Theory of Reasoned
Action. Farris and Kirking (1995) investigated the

association among pharmacists' attitudes, social norms,
self-reported past behavior and the intention to try to
31
prevent and correct potential drug-therapy problems.

Odedina et. a l . (1997) used the Theory of Planned Behavior to
create the pharmacists' implementation of the pharmaceutical
care model.
Farris and Kirking (1995) examined the relationships
among community pharmacists' attitudes, social norms, self-

reported past behavior and the intention to try to prevent
and correct potential drug-therapy problems. They also
examined the effects of potential modifiers such as action-
control and self-schemata on the predictors of intention to
try. They surveyed Michigan community pharmacists (n=167)
and, based upon a 67.3 percent response rate, reported that
attitude was positive and intention to try preventing and

correcting drug-therapy problems was high. Intention to try
was predicted by attitude (P=0.17), and social norm toward
trying (P=0.26), after controlling for recency of past

trying (R2=0.18). Action control did not moderate the
effects of attitude and social norm. Self-schemata
moderated predictors of intention to try, specifically the
frequency of past trying (Farris and Kirking, 1995).

Odedina et al (1997) developed a theoretical framework
to explain pharmacists' behavior relative to the provision
of pharmaceutical care. Their model was developed from four

attitude models: the Theory of Reasoned Action; the Theory
of Planned Behavior; the Theory of Trying; and the Theory of
32
Goal-Directed Behavior. They surveyed Florida community
pharmacists (n=617) twice using a mail survey. The first
survey assessed pharmacists' attitude, subjective norm,
perceived behavioral control, past behavior recency, self-

efficacy, instrumental beliefs and affect. Their second
survey assessed pharmacists' behavior relative to the
implementation of pharmaceutical care.
Their regression models suggested that behavior was
directly determined by past behavior recency (P=0.65),
behavioral intention (P=0.15), and perceived behavioral

control (p=0.13) with R2=0.57. Behavioral intention was
determined by attitude (P=0.38), social norm (P=0.14), and

perceived behavioral control (P=0.29) with R2=0.44.
Intention alone as a predictor of behavior explained a
significant 14 percent of variance. The proportion of
variance (R2)increased to 20 percent when perceived
behavioral control was added to the regression model with
the regression coefficients (P)0.23 for intention and 0.29
for perceived behavioral control. When past behavior was
added to intention in the prediction of pharmacists'
behavior, past behavior improved the overall explanatory
power of behavior (R2) by 41 percent with the regression
coefficients 0.14 for intention and 0.68 for past behavior.
The incremental R2 on adding the appraisal processes —
self-efficacy, instrumental beliefs, and affect toward means
33
— to past behavior to predict behavior was small (from 0.49

to 0.51) and none of the appraisal processes nor their
interaction were significant. Only the past behavior
predictor was significant ((5=0.65). A regression model with
only the appraisal processes and their interaction variables
in the absence of past behavior was found to be significant

(R2=0.14). They concluded that psychological appraisal
processes influenced behavior through past behavior recency

(Odedina et al, 1997).
Farris and Schopflocher (1999) explored the
relationship between intention to try and trying behaviors
pertaining to pharmaceutical care provision among community
pharmacists. Two surveys were used in this study: an
attitude survey and a behavior survey. The first survey

assessed intention to try, self-efficacy, beliefs, affect
and perceived behavioral control. The second survey
assessed whether pharmacists had completed the 20 behaviors

relative to pharmaceutical care for one patient during the
past 2 weeks. They developed a causal model for predicting
pharmaceutical care behaviors from pharmacists' self-
efficacy, beliefs, evaluations, and behavioral control with

the proposed ordering as behavioral control, beliefs,
evaluation, self-efficacy, behavior. They concluded that

perceived behavioral control and self-efficacy are critical
34
to pharmaceutical care behaviors (Farris, Schopflocher,

1999).
From these studies, social cognition concepts contained

in the Theory of Planned Behavior can influence pharmacists
to provide pharmaceutical care. However, these studies did
not account for the contribution of pharmacists' personality

to behavior relative to pharmaceutical care.
Behavior Relative to Pharmaceutical Care
Over the past 150 years, the pharmacy profession has
moved from manufacturing, to compounding, to distribution,
to a more clinical role, and finally to pharmaceutical care.
Hepler and Strand defined pharmaceutical care as "the

responsible provision of drug therapy for the purpose of
achieving definite outcomes that improve a patient's quality
of life" (Hepler & Strand, 1990 p.539). Individual practice

sites currently vary widely in their provision of
pharmaceutical care. Nimmo and Holland (1999) depict the
current practice of pharmacy as a mixture of five distinct
practice models: drug information practice model, self-care
practice model, clinical pharmacy practice model,
pharmaceutical care practice model, and distributive

practice model. The pharmaceutical services required to
meet a population's need require pharmacists to perform in
all of these practice models (Nimmo and Holland, 1999) .
Even though the pharmaceutical care model is not the only
35
acceptable practice model in the pharmacy profession, most

leaders in the profession agree about the future direction
of pharmacy. Pharmacists will adopt the practice philosophy
of pharmaceutical care (Nimmo and Holland, 1999). The

current study will emphasize pharmacists behavior relative
to pharmaceutical care practice.
Generally, in practicing pharmaceutical care,

pharmacists will collect all patient-specific information
needed to prevent, detect, and resolve drug-related
problems. They will make appropriate therapeutic
recommendations for their patients. Pharmacists will also
determine the patient's present medication and related

therapeutic problems. When the problem is identified, they
will develop pharmacotherapeutic and related health care
goals with the patient or caregiver which put together
patient-specific, disease-specific and drug-specific

information, and ethical and quality-of-life considerations.
They will also develop or modify an existing monitoring plan
for the patient7s regimen to evaluate the achievement of

pharmacotherapeutic and related health care goals in
cooperation with the patient or caregiver. Pharmacists will
confirm the patient's care plan with relevant members of the
patient care team, implement the pharmacist's care plan, and
modify the care plan as necessary on the basis of monitoring
data. In addition, pharmacists will provide counseling to
36
patients and caregivers, including information on drug

therapy, adverse effects, compliance, appropriate use,
handling, and medication administration (Nimmo and Holland,
1999).
Three primary activities must occur for pharmaceutical
care to be delivered. First, documentation is critical for

supporting other activities. Data in the documentation
system serve as the source of information necessary to
generate relevant care plans for patients. Second, patient

assessment or patient interview is essential for determining
how to best meet the patient's needs and what concerns a
patient has because only the patient can provide information
relating to subjective concerns. Third, the most important
step of care planning is establishing goals for resolving

drug-related problems in order to achieve therapeutic goals
for the patient's medical condition and to prevent new
problems. The present study focused on these three primary

key sets of activities for pharmaceutical care provision,
which were documentation activities, patient assessment

activities, and drug-related problem resolution activities.
The provision of pharmaceutical care requires a
documentation system to support the practice. All
information about patient's medications, medical conditions,

care plan and interventions must be documented.
Pharmaceutical care cannot be effectively provided without
37
this information because these data are the source of
information necessary to detect, prevent, and resolve

medication-related problems. Documentation activities of
pharmacists are a part of pharmaceutical care provision.

Patient assessment is another process in providing
pharmaceutical care. The goal of the assessment is to

identify drug-related needs and any drug-related problems
for determining the most appropriate, most effective, the
safest, and most convenient drug therapy for the patient;
and to identify any drug therapy problems that might be
interfering with the goals of therapy or that the pharmacist
can help the patient to prevent in the future (Cipolle,

Strand, and Morley, 1998). The patient-assessment process
can be achieved by asking the patient questions to assess

actual patterns of medication use, to find out any drug-
related problems and the perceived effectiveness of drugs he
or she was taking, and to ascertain whether the therapeutic
objectives were being reached (Odedina and Segal, 1996).
When a problem is identified, the implementation of
therapeutic objectives and monitoring plan is provided to

the patient. These processes consist of implementing a
strategy to resolve or prevent drug-related problems,
establishing follow-up plans to evaluate the patient's

progress toward his therapy objectives, and carrying out the
follow-up of these care plans.
38
From these pharmaceutical care activities, the

essential attribute of pharmaceutical care practice is a
caring and collaborative relationship with the patient and
with other care providers for the patient (Hepler and
Angaran, 1996; Nimmo and Holland, 1999). Pharmacists,
therefore, who provide pharmaceutical care must be empathic
to form caring relationships and assertive to carry out
their ethical and moral responsibilities toward patients.
It would seem likely that some pharmacists will not be
comfortable with the expectations demanded of the new

practices because of their unique personality
characteristics. For example, individuals choose pharmacy

as a professional career based on their unique personality
composition and its relationship to the perception of the
activities that pharmacists do. The personality of

pharmacists might affect the way they choose to perform this
new practice and consequently, influence their provision of
pharmaceutical care. This, therefore, creates an
interesting practice-based research question of how the

basic structures of personalities of pharmacists
significantly contribute to the explanation of behavior
relative to pharmaceutical care.
Pharmacy Practice Environment

All new ideas face obstacles if their environments are
not conducive to the innovation. Pharmacy is in a period of
39
transition to a new philosophy of practice. Efforts to

encourage practice change in pharmacy should not be focused
only on the individual pharmacist, as there must be an
encouraging environment for pharmacists to engage in new
practice activities. Literature on innovation identifies

the environment as one factor that can affect the change
process (Doucette, DeSloover, 2000) . The present study

investigated the unique effects of personality and social
cognitions on behavior by controlling for the practice
environments that can affect the provision of pharmaceutical
care.
There are numerous environmental factors that can
either facilitate or obstruct the pharmacist's provision of
pharmaceutical care activities, for example, types of

practice setting (Penna, 1990), adequacy of resources
(Rovers, Currie, Hagel, McDonough, and Sobotka, 1998), and

pharmacist's workload. Some pharmacists may have a high
workload or high numbers of prescriptions that prevent them
from doing pharmaceutical care activities. The adequacy of

resources such as personnel support space and computer
systems can facilitate the provision of pharmaceutical care.
To provide pharmaceutical care to patients, pharmacists need
to free their time from other functions, which can only be

done with the proper use of technicians and auxiliary
personnel (Rovers, Currie, Hagel, McDonough, and Sobotka,
40
1998) . An area dedicated to providing patient care in
privacy is also important. Without it, patients may not be

willing to provide their medical information to pharmacists
because of concern about confidentiality (Rovers, Currie,
Hagel, McDonough, and Sobotka, 1998). Drug information
search systems or databases used in pharmaceutical software
packages such as MicroMedex, Medi-Span, and U .S .Pharmacopeia
Drug Information can facilitate identifying drug-related

problems and help develop patient care plans in
pharmaceutical care provision. A computer system that helps
pharmacist store patient data, screen for drug-related
problems, document interventions, develop patient care
plans, and evaluate outcomes can facilitate pharmaceutical

care activities.
In conclusion, this study grouped the practice

environment into three factors and used these factors as
control variables because they appeared to influence the
provision of pharmaceutical care activities. These three
main factors were type of practice setting, workload, and
the adequacy of resources. The adequacy of resources in

this study included personnel support, space, computer
system, and drug information database system.
41
Proposed Mediators of Social Cognition

Between Personality and Behavior
Relative to Pharmaceutical Care
For behavior that is not automatic, intention and
perceived behavioral control have influences on behavior
(Ajzen, 1985). Intentions are assumed to capture the
motivational factors that have an impact on a behavior; they
are indications of how hard people are willing to try, and
of how much effort they expect to exert in order to perform
the behavior. People form intentions to engage in a certain

behavior. At the appropriate time and opportunity, their
intention is translated into action. Therefore, the present

study focused specifically on the role of intentions as a
mediator in the associations between five basic structures
of personality and behavior relative to pharmaceutical care.
This was because 1) behavior is strongly influenced by
behavioral intentions as addressed in the Theory of Planned
Behavior; 2) personality has direct influence on behavior;

and 3) behavioral intention was found to have an association
with some of the five factors of personality (Bond and
Forgas, 1984) .
Any omitted variables that influence both the outcome
and the mediating variable can result in a biased estimate
of mediational analysis (Judd and Kenny, 1981) . Behavioral
intention was chosen to examine the mediational path link
42
between personality and behavior. To reduce biased
estimates of the mediation process, therefore, both practice

environment and perceived behavioral control were controlled
in the analysis because they have influence on behavioral
intention and behavior.
Proposition Statements
The present study first investigated the effect of five

factors of personality on behavior relative to
pharmaceutical care. The primary proposition was:
1) That extraversion, conscientiousness, agreeableness,
and openness have direct positive effects, and neuroticism
has a direct negative effect, on pharmacists' self-reported
behavior related to pharmaceutical care, controlling for
practice environment (Figure 1).

To test a theoretical model that integrates the five
basic structures of personality and social cognitions
contained in the Theory of Planned Behavior to predict
behavior the following research question was explored:
2) What variables among the five basic structures of
personality and social cognition constructs proposed by the
Theory of Planned Behavior directly determine pharmacists'
self-reported intention and behavior relative to

pharmaceutical care, controlling for practice environment
(Figure 2 and 3)?
43
To examine the mediational path of behavioral intention

that links the basic personality structures to behavior, a
mediational analysis was conducted. The secondary
proposition associated with the mediational analysis was:
3) That behavioral intention would serve as a mediator
in any associations between the five basic structures of
personality and behavior relative to pharmaceutical care
provision, controlling for practice environment and

perceived behavioral control (Figure 4).
Hypothesized Models
Extraversion
Conscientiousness
Agreeableness
Pharmaceutical
Care Provision
Openness
Neuroticism
-Practice Setting
-Workload
-Adequacy of Resources
Figure 1. The Hypothesized Model for Research

Question 1
45
Personality
Attitude
Subjective Norm Intention
Perceived
Behavioral
Control
-Practice Setting
-Workload
Figure 2. The First Hypothesized Model for Research

Question 2
46
Personality
Intention
Pharmaceutical
Care Provision
Perceived
Behavioral
Control
-Practice Setting
-Workload
Figure 3. The Second Hypothesized Model for Research

Question 2
47
Personality
Intention Pharmaceutical
Care Provision
Perceived
Behavioral
Control
-Practice Setting
-Workload
Figure 4. The Hypothesized Model for Research

Question 3
48
CHAPTER III
METHODOLOGY
The first purpose of this study was to determine the

association between personality and self-reported behavior
by controlling for practice environmental factors. As
described in chapter II, not only can personality affect
behavior, but social cognitions can also affect behavior.
Therefore, the second purpose of this study was to test a
theoretical model that integrates the five basic structures
of personality and social cognition constructs contained in

the Theory of Planned Behavior to predict the pharmacist's
behavior related to pharmaceutical care. The last purpose
was to investigate whether behavioral intention, the
construct contained in the Theory of Planned Behavior,
mediated the relationship between personality and behavior.
This section presents the methods and procedures of the

study, namely the definitions of variables and their
operationalization, sample population, research instruments,
treatment of the data and data analysis.
Research Design
The design of this study was a cross-sectional survey.
The self-administered questionnaire was mailed to the sample
49
subjects. A single questionnaire was used in this study

because the major.aim was to investigate the association
among variable constructs, not to find the causation between
variables. The questionnaire consisted of four main parts.

The first part was the personality instrument. The second
part consisted of a pharmaceutical care behavior measure, an

intention measure, an attitude measure, a subjective norm
measure, and a perceived behavioral control measure. The
third part was the pharmacy practice environmental component
measure. The last part was a set of demographic questions.
Study Variables and Measurements
Personality:
The Five-Factor Model
The Big Five Inventory (BFI) (John, Donahue and Kentel,

1991) was used to measure the personality traits indicated
in the Five Factor Model of Personality. It was developed
by researchers at the Institute of Personality and
Assessment and Research at the University of California at
Berkeley. The BFI measured the prototypical components of

the Big Five personality dimensions, which were labeled as
Extraversion, Neuroticism, Agreeableness, Conscientiousness,
and Openness. This instrument consists of 44 items. It was

developed through expert ratings and subsequent factor-
analytic verification in personality ratings by observers
50
(John and Srivastava, 1999). When there is no requirement

to differentiate individual facets in the basic structure of
personality, BFI provides efficient and flexible assessment
of the five dimensions (John and Srivastava, 1999) . The Big
Five Inventory (BFI) uses short phrases based on the trait
adjectives known to be prototypical markers of the Big Five.

BFI was selected from among many available instruments to
measure personality for several reasons. First, it was
constructed to enable its use with average people. Second,
the content in the instrument is not offensive. Third, the
average time to respond to the full BFI is 5 minutes.
Fourth, the language used in the instrument is easy to

understand by the lay person. Fifth, scoring is objective.
Sixth, the results are easy to interpret.
Each item in the BFI is rated on a 5-point Likert-type
scale ranging from 1 (strongly disagree) to 5 (strongly
agree). The Extraversion dimension is measured by 8 items.
The Neuroticism dimension is measured by 8 items. The
Agreeableness dimension is measured by 9 items. The

Conscientiousness dimension is measured by 9 items. The
Openness dimension is measured by 10 items. The items
representing the five dimensions of personality of the Big
Five Inventory are presented in Tables 2, 3, 4, 5, and 6.
51
Table 2. Items for Measuring Extraversion
1. I see myself as someone who is talkative.
2. I see myself as someone who is reserved.
3. I see myself as someone who is full of energy.
4. I see myself as someone who generates a lot of enthusiasm.
5. I see myself as someone who tends to be quiet.
6. I see myself as someone who has an assertive personality.
7. I see myself as someone who is sometimes shy, inhibited.
8. I see myself as someone who is outgoing, sociable.
Table 3. Items for Measuring Neuroticism
1 . I see myself as someone who is depressed, blue.
2. I see myself as someone who is relaxed, handles stress

well.
3. I see myself as someone who can be tense.
4 . I see myself as someone who worries a lot.
5. I see myself as someone who is emotionally stable, not

easily upset.
6. I see myself as someone who can be moody.
7. I see myself as someone who remains calm in tense

situations.
8. I see myself as someone who gets nervous easily.
Table 4. Items for Measuring Agreeableness
1 . I see myself as someone who tends to find fault with

others.
2. I see myself as someone who is helpful and unselfish.
3. I see myself as someone who starts quarrels with others.
4 . I see myself as someone who has a forgiving nature.
5. I see myself as someone who is generally trusting.
6 . I see myself as someone who can be cold and aloof.
7. I see myself as someone who is considerate and kind to

almost everyone.
8. I see myself as someone who is sometimes rude to others.
9. I see myself as someone who likes to cooperate with

others.
Although the Big Five Inventory scales include only

eight to ten items, they do not sacrifice either content
coverage or good psychometric properties. In U.S. and

Canadian samples, the alpha reliabilities of the Big Five
Inventory scales typically range from 0.75 to 0.90 and
average above 0.80; the three-month test-retest
reliabilities range from 0.80 to 0.90, with a mean of 0.8 5

The substantial convergent and divergent relations with
other Big Five instruments as well as with peer rating
provide evidence of its validity (John and Srivastava,

1999). The Big Five Inventory also has convergent and
53
Table 5. Items for Measuring Openness
1 . I see myself as someone who is original, comes up with new

ideas.
2. I see myself as someone who is curious about many

different things.
3. I see myself as someone who is ingenious, a deep thinker.
4. I see myself as someone who has an active imagination.
5 . I see myself as someone who is inventive.
6. I see myself as someone who values artistic, aesthetic

experiences.
7. I see myself as someone who prefers work that is routine.
8. I see myself as someone who likes to reflect, play with

ideas.
9. I see myself as someone who has few artistic interests.
10 . I see myself as someone who is sophisticated in art,

music, or literature.
divergent relation with other instruments such as Costa and
McCrae's NEO questionnaire (Neuroticism, Extraversion,
Openness, Five Factor Inventory) (Costa and McCrae, 1992)

and Goldberg's 100-item Trait-Descriptive Adjectives (TDA:
unipolar Big Five factor markers) (Goldberg, 1992).
In general, Costa and McCrae's NEO questionnaire (Costa
and McCrae, 1992) represents the most-valid Big Five
measures in the questionnaire tradition (John and
Srivastava, 1999). Goldberg's 100-item TDA (Goldberg, 1992)
54
Table 6. Items for Measuring Conscientiousness
1. I see myself as someone who does a thorough job.
2. I see myself as someone who can be somewhat careless.
3. I see myself as someone who is a reliable worker.
4. I see myself as someone who tends to be disorganized.
5. I see myself as someone who tends to be lazy.
6. I see myself as someone who perseveres until the task is

finished.
7. I see myself as someone who does things efficiently.
8. I see myself as someone who makes plans and follows

through with them.
9. I see myself as someone who is easily distracted.
is the most commonly used measure consisting of single
adjectives (John and Srivastava, 1999). The BFI has been

used frequently in research settings in which subject time
is at a premium, and the short-phrase item format provides
more context than Goldberg's single adjective items but less

complexity than the sentence format used by the NEO
questionnaires (John and Srivastava, 1999). Few studies
have compared these two instruments with each other (Benet-
Martinez and John, 1987; Goldberg, 1992).
There is a study from a large data set of self-reports

on all three instruments (John and Benet-Martinez, 2000).
Their study provides the evidence of convergent and
55
divergent validity. The sample consisted of 4 62

undergraduates at the University of California, Berkeley,
who completed the TDA, the NEO-FFI, and the BFI.
Multitrait-multimethod design was used in their analysis in

which the methods are three self-report instruments. The
results showed that TDA scales had the highest alpha
reliabilities (mean of alpha reliability from five
dimensions is 0.89), followed by the BFI (0.83) and the NEO-
FFI (0.79). Across all five factors, the mean of the
convergent validity correlation across instruments was 0.75.

The BFI and TDA showed the strongest convergence (mean r =
0.81), followed by the BFI and NEO-FFI (mean r = 0.73), and
the TDA and NEO-FFI (mean r = 0.68). Overall, discriminant
correlations were low. The absolute values averaged 0.21

for the TDA, 0.17 for the NEO-FFI, and 0.20 for the BFI.
None of the discriminant correlations reached 0.4 0 on any of
the instruments (John and Srivastava, 1999) .
Pharmaceutical Care Provision

In the current study, pharmaceutical care provision was
the dependent variable. The measure for this dependent

variable was developed from the Behavioral Pharmaceutical
Care Scale (BPCS), which offers a multi-item scale for
pharmacists'' behavior relative to the provision of

pharmaceutical care (Odedina and Segal, 1996). The measure
for pharmaceutical care provision in the current study was
56
made up of 11 behavioral activities, which represented three
pharmaceutical care dimensions including patient assessment,

drug-related problem resolution, and documentation. These
three dimensions were chosen because they are the main
elements of pharmaceutical care provision. Ajzen and
Fishbein (1980) suggested defining the behavior of interest
in terms of action, target, context, and time. The scale

consisted of 11 items that represent the above three
dimensions. The items for each dimension are presented in

Tables 7, 8 and 9.
Pharmacists were asked to indicate for how many of
their last five patients these activities had been provided.
The score of each activity ranged from zero for none of the
Table 7. Items of The Patient Assessment Dimension
1. Asking the patient questions to assess actual patterns of

use of the medication.
2. Asking the patient questions to find out if he or she

might be experiencing drug-related problems.
3. Asking the patient questions to find out about the

perceived effectiveness of drugs he or she is taking.
4. Asking the patient questions to ascertain whether the

therapeutic objective(s) is (are) being reached.
57
patients to five for all of the patients. The
pharmaceutical provision score was a sum of all eleven items

and ranged from 0 to 55.
Table 8. Items of The Drug-related Problem Resolution

Dimension
1. Monitoring drug therapy to identify drug-related problems.
2. Implementing a strategy to resolve (or prevent) the drug-

related problem.
3. Following-up the plan established for resolving the

patient's drug-related problems.
Table 9. Items of The Documentation Dimension
1. Documenting information about the patient's medical

conditions on written records or computerized notes or by
other formal mechanisms in a form that can be read and
interpreted by another health care practitioner in my
absence.
2. Documenting all medications currently being taken by the

patient on the written records or computerized notes or by
other formal mechanisms in a form that can be read and
interpreted by another health care practitioner in my
absence.
3. Documenting the drug-related problems, potential or

actual, on written notes.
4. Documenting any intervention made on the patient's

profile, prescription, report, or medical order in a form
that can be read and interpreted by another health care
professional.
58
Behavioral Intention
Behavioral intention is one of the concepts in the
Theory of Planned Behavior. The Theory of Planned Behavior
posits that behavioral intentions are a measure of
likelihood that a person will engage in a given behavior
(Ajzen and Fishbein, 1980). The list of items used to
measure behavioral intention to provide pharmaceutical care
activities was developed based on the suggestion by Aj zen
and Fishbein. They suggested defining the behavioral
intention corresponding to the behavior of interest and
using specific phrases and adjectives for the behavioral

intention (Ajzen and Fishbein, 1980) such as the example in
Figure 5.
"I intend to...in the next..."

likely_____ :_____ :_____ :_____ :_____ :_____ :_____ unlikely
e x t r e m e l y q u i t e s l i g h t l y ne i t h e r / s l i g h t l y q u i t e e x t r e m e l y
nor
"I will do... in the next...":

probable_____ :_____ :_____ :_____ :_____ :_____ :_____ improbable
e x t r e m e l y q u i t e s l ightly n e i t h e r / s l i g h t l y q u i t e e x t r e m e l y
nor
Figure 5. An Example of Specific Phrases and Adjectives for

Behavioral Intention Suggested by Aj zen and
Fishbein (1980)
59
In the study of Farris and Schopflocher (1999), they
measured behavioral intention by asking, "I intend to try to

provide all pharmaceutical care activities for one patient
in my practice during the next two weeks" with a seven-point
response scale anchored by extremely unlikely and extremely
likely, and, "During the next two weeks, I plan to try to

provide all pharmaceutical care activities for one patient
in my practice" with a seven-point response scale anchored
by extremely disagree and extremely agree (Farris and
Schopflocher, 1999). Odedina et al (1997) measured
behavioral intention by asking "I intend to try to provide
pharmaceutical care within the next six weeks" on a seven-

point likely/unlikely response scale and "I will provide
pharmaceutical care in the next six weeks" on a seven-point
agree/disagree response scale (Odedina et al, 1997).
In the current study, pharmacists were asked to
indicate the likelihood for each dimension of the
pharmaceutical care provision (3 groups of activities) on
the semantic differential-type response scales ranging from

1 to 7, with 1 representing an "extremely unlikely" anchor
and 7 representing an "extremely likely" anchor. The items
used to measure the behavioral intention are presented in
Table 10. The total behavioral intention score was the sum
of the scores of the 3 items.
60
Attitude toward
The attitude measure was designed to assess the concept

of the Theory of Planned Behavior in relation to attitude
toward providing pharmaceutical care activities. Attitude
is a person's general feeling of favorableness or
unfavorableness for the behavior under consideration (Ajzen

and Fishbein, 1980). Ajzen and Fishbein (1980) suggested
Table 10. Items for Measuring Behavioral Intention
1 . I intend to perform the above patient assessment activities

for one of my patients who presented a refill prescription
used to treat a chronic condition such as asthma, diabetes,
or hypertension in the next two weeks.
2. I intend to perform the above drug-related, problem

resolution activities for one of my patients who I
discovered was experiencing drug-related problems in the
next two weeks.
3. I intend to perform the above documentation activities for

one of my patients who presented a prescription for new
medications used to treat a chronic condition such as
asthma, diabetes, or hypertension or who I discovered was
experiencing drug-related problems in the next two weeks.
that one alternative method to measure attitude is to ask
that the respondent provide a direct indication of his or

her attitude in the following manner (Figure 6).
61
"My attitude toward my voting in the forthcoming

election i s "
favorable_____ :_____ :_____ :_____ :_____ :_____ :_____ unfavorable
extremely quite slightly neither/ slightly quite extremely
nor
Figure 6. An Example of Attitude Measure Suggested by Ajzen

and Fishbein (1980) .
In the study of Farris and Kirking (1995), they
measured general attitude toward trying by asking "My trying
to prevent and correct patients' potential drug-therapy
problem on a typical day during the next two weeks will make
me feel..." on a seven-point bad/good, unpleasant/pleasant,
and negative/positive response scale (Farris and Kirking,

1995) . Odedina et al (1997) measured attitude toward
behavior by asking "My opinion about providing
pharmaceutical care to patients in the next six weeks is
..." on a seven-point favorable/unfavorable response scale
(Odedina et al, 1997).
A direct measure of attitude was used in this study.

The pharmacists were asked to indicate the level of
favorableness for each of the dimensions of pharmaceutical
care activities on the semantic differential-type response
scales ranging from 1 to 7, with 1 representing an
"extremely unfavorable" anchor and 7 representing an
"extremely favorable" anchor. The total attitude toward
62
pharmaceutical care score was the sum of the scores of the 3

items. The items used to measure the attitude toward
behavior are presented in Table 11.
Subjective Norm
Subjective norm is the social level determinant of
intention. It refers to the person's perception that most
people who are important to him think he or she should or

should not perform the behavior in question. This
perception may or may not reflect what important others
Table 11. Items for Measuring Attitude toward

1 . My opinion about performing the above patient: assessment

activities for one of m y patients who presented a refill
prescription used to treat a chronic condition such as
asthma, diabetes, or hypertension in the next two weeks is:
2. My opinion about performing the above drug-related problem

resolution activities for one of my patients who I
discovered was experiencing drug-related problems in the
next two weeks is:
3. My opinion about performing the above documentation

activities for one of m y patients who presented a
prescription for new medications used to treat a chronic
condition such as asthma, diabetes, or hypertension or who
I discovered was experiencing drug-related problems in the
next two weeks is:
63
actually think he ,or she should do. Ajzen and Fishbein

(1980) suggested that the format in Figure 7 can be used to
assess a person's subjective norm.
Most people who are important to me think

I should :_____ :_____ :_____ :_____ :_____ :_____ I should not
perform behavior X.
Figure 7. An Example of Subjective Norm Measure

Suggested by Ajzen and Fishbein (1980)
In the study of Farris and Kirking (1995), they
measured social norm toward trying by asking, "Most people

or groups who are important to me approve or disapprove of
me trying to prevent and correct patients' potential drug-
therapy problem on a typical day during the next two weeks"
on a seven-point disapprove/approve response scale (Farris

and Kirking, 1995). Odedina et al (1997) assessed
subjective norm by indirect measure. They measured
subjective norm by summing up the products of normative
beliefs and the corresponding motivations to comply (Odedina

et al, 1997).
A direct measure of subjective norm was used in the

current study in the same way as the attitude measure. The
pharmacists were asked to indicate the level of agreement on
64
the statement for each item on the semantic differential-

type response scales ranging from 1 to 7, with 1
representing an "extremely disagree" anchor and 7
representing an "extremely agree" anchor. The total
subjective norm score was the sum of the scores of the 3

items. The items used to measure the subjective norm are
presented in Table 12.
Perceived Behavioral Control
Perceived behavioral control is the person's perception

of how easy or difficult it would be to perform the
behavior. It is assumed to reflect past experience as well
Table 12. Items for Measuring Subjective Norm
1. Most people who are important to me think I should perform

the above patient assessment activities for one of my
patients who presented a refill prescription used to treat a
chronic condition such as asthma, diabetes, or hypertension
in the next two weeks.

the above drug-related problem resolution activities for one
of my patients who I discovered was experiencing drug-
related problems in the next two weeks.

the above documentation activities for one of my patients
who presented a prescription for new medications used to
treat a chronic condition such as asthma, diabetes, or
hypertension or who I discovered was experiencing drug-
related problems in the next two weeks.
65
as anticipated impediments and obstacles (Ajzen, 1991;

Montano, Kasprzyk, and Taplin, 1997). Because perceived
behavioral control was added to the theory of reasoned
action relatively recently (Ajzen and Madden, 1986), there
is no real consensus about the most appropriate way in which
to measure this construct on the basis of its underlying

beliefs (Manstead and Van Eekelen, 1998).
Perceived behavioral control has typically been
operationalized directly by asking respondents how much
control they feel they have over the behavior in question,
or how easy or difficult they feel it would be to perform
the behavior in question (Madden, Ellen and Ajzen, 1992).
Most of the studies have used a single overall measure of
perceived behavioral control rather than computing perceived

behavioral control from measures of control beliefs and
perceived power concerning specific facilitators and
barriers (Montano, Kasprzyk and Taplin, 1997).
In the study of Farris and Schopflocher (1999), they
measured perceived behavioral control by asking "How easy or
difficult [is it] for you to perform each of the 20

pharmaceutical care activities for one patient who regularly
obtains medication in your practice during the next two
weeks" on a seven-point difficult/easy response scale.
Odedina et al (1997) assessed perceived behavioral control
by asking, "For me, providing pharmaceutical care within the
66
next six weeks is ..." on a seven-point difficult/easy

response scale.
In the current study, a direct measure of perceived

behavioral control was used. The pharmacists were asked to
indicate the level of ease or difficulty to perform each of
the dimensions of pharmaceutical care activities on the
semantic differential-type response scales ranging from 1 to
7, with 1 representing an "extremely difficult" anchor and 7
representing an "extremely easy" anchor. The total
perceived behavioral control score was the sum of the scores

of the 3 items. The items used to measure the perceived
behavioral control are presented in Table 13.
Table 13. Items for Measuring Perceived Behavioral

Control
1 . For me, performing the above patient assessment activities

for one of my patients who presented a refill prescription
used to treat a chronic condition such as asthma, diabetes,
or hypertension in the next two weeks i s :
2. For me, performing the above drug-related problem resolution

activities for one of my patients who I discovered was
experiencing drug-related problems in the next two weeks is:
3. For me, performing the above documentation activities for

one of my patients who presented a prescription for new
medications used to treat a chronic condition such as
asthma, diabetes, or hypertension or who I discovered was
experiencing drug-related problems in the next two weeks is:
67
Practice Environment
Pharmacy practice environmental components emphasized
in the present study consisted of three factors: type of
practice setting, pharmacist's workload, and adequacy of
resources. These factors can facilitate or inhibit
pharmacists in performing pharmaceutical care activities.

Thus, these variables were controlled in every analysis of
each hypothesis by entering them in the regression

equations.
Types of practice setting
Type of practice setting was measured with the

following question, "Please check one item that best
describes your employment setting." Pharmacists were
directed to choose the answer choices as presented in Table

14.
Table 14. Item and Answer Choices for Measuring the Type
of Practice Setting
Please check one item that best describes your employment

setting.
O Community Pharmacy (indep./small chain/clinic)
O Community Pharmacy (chain, >10 units)
O Clinic Pharmacy
O Hospital Pharmacy
O Nursing Home/Long Term Care
O Other (describe):
68
Workload
The number of prescriptions dispensed per day by a
pharmacist can directly reflect the workload of pharmacists
which, if heavy, will prevent him from providing
pharmaceutical care. A single item was used to measure the
pharmacist's workload. Pharmacists were asked to indicate

the average number of prescriptions per day, and the
approximate working hours per day. The item used to measure
the workload is shown in Table 15.
Table 15. Item for Measuring Workload
The average of prescriptions you personally are involved with

(dispensing/consulting on) during a workday
Rx's in a __________ hour day____________________ ._
(Number of prescriptions) (Number of hours/day)
Adequacy of Resources
As mentioned earlier, the adequacy of resources such as
space, computer system, trained personnel, and pharmacist's
skills can facilitate the provision of pharmaceutical care.
The adequacy of resources measurement consisted of 5

questions asking about adequacy of space, computer system,
personnel, and pharmacist skill. The pharmacists were asked

to rate the level of adequacy of these resources in the
pharmacy in which they are working on the 6-point Likert
69
scales ranging from 1 to 6, with 1 representing "very poor",

2 representing "poor", 3 representing "fair", 4 representing
"good", 5 representing "very good", and 6 representing
"excellent". The total adequacy of resources score was the
sum of the scores of the 4 items. The items used to measure
the adequacy of resources are presented in Table 16.
Table 16. Items for Measuring the Adequacy of

Resources
1.An area in the pharmacy where you can counsel or talk with
patients in private or semi-private manner (your
conversations cannot be easily overheard by other
individuals).
2. A computer system which helps you store patient data and

screen for drug-related problems.
3. A computer system which helps you develop patient care

plans and evaluate outcomes.
4. Trained pharmacy personnel that can perform some of your

tasks so that you can spend more time on pharmaceutical
care activities.
Demographic Characteristics
Background information to describe the pharmacist
population included age, gender, ethnic background,
educational level, years of licensing, marital status,
ownership, current position and the county and zip code of
the primary place of employment. Pharmacists were asked to

indicate the year that they were born and year first
70
licensed as a pharmacist to determine their age and years of

licensing, and to indicate the percent of the extent of
pharmacy ownership. Gender, ethnic background, educational
level, marital status, and current position were asked by
using a nominal scale. They also were asked to indicate the
name and zip code of their primary place of employment.
Population and Sample
Sample Frame
The sampling frame consisted of all pharmacists
registered in Iowa and living in Iowa as recorded in a
printed alphabetical listing by the Iowa Pharmacy

Association in September 1999.
Sample Size
The sample size was calculated assuming the size of
population = 2,846. The maximum allowable difference of the

sample estimate means and the true unknown population
parameter means in absolute value equaled 0.1. With the
assumption of normal distribution, the variance estimate was

assumed to be 1.0. The desired confidence level was set at
95%. Using these assumptions, the sample size determined to
be representative was 33 9. It was an adequate sample size
to be virtually certain of estimating means within 10% of
the true means in the population as a whole and allowed us
71
to be 95% confidence that our estimates had a sampling error

no more than 5%.
The response rate was expected to be 60 percent. This

made the sample size 565. To account for nondeliverable
addresses, this sample size of 565 was increased to 600. A
systemic random sampling procedure was used to draw
pharmacists' names from the list of the Iowa Pharmacy
Association in September 1999.
Pretest
The questionnaire was pretested by asking several
people, including faculty members and graduate students in
the Pharmaceutical Socioeconomics program of the College of
Pharmacy, to respond to the question items. These people
were also asked to evaluate the clarity of the wording, the
face validity, comprehension level of language (specificity,

sensitivity), and the formatted appearance of the
questionnaire.
Pilot Test
The pilot test was- conducted to obtain an estimate of
the response rate and to guide in developing the
questionnaire. Fifty pharmacists were randomly selected
from the sample frame. A questionnaire with a cover letter
and a stamped return address envelope was sent to each of
the randomly selected pharmacists. A follow-up postcard was
72
sent to subjects who did not return the questionnaire. Data
were analyzed for temporal stability and internal
consistency. The questionnaire was reviewed and a few items

were eliminated or reworded.
Data Collection
Data were collected from the pharmacists in Iowa by a
self-administered questionnaire mail survey. A study

announcement letter was sent to the selected participants
regarding the study purposes, the coming questionnaire, the

confidentiality of their responses, and the provision of the
study results if needed. The final questionnaire was four
pages long. One week after sending this first letter, a
cover letter, a self-administered questionnaire, and a

stamped return address envelope were sent to the selected
subjects. For the convenience of follow-up mailing, each
questionnaire was assigned a code number. Each code number

was written in pencil at the left corner of the back of the
last page of the questionnaire. In the cover letter, the
sample subjects were informed that they could erase or tear
off this number if they preferred. The first follow-up post
card was sent to those who did not return the questionnaire
one week after sending the questionnaire. Two weeks later,

a follow-up questionnaire was sent again to those who did
not respond. Two weeks after sending the second
questionnaire, a second follow-up post card was sent again.
73
Data Coding and Cleaning
A codebook was created in order to facilitate the data

coding and entry. All item responses in the questionnaire
were converted into numbers for data analyses. The validity
and reliability of entering data were assessed by double
checking each variable entered.
Data Analysis
Several statistical methods were used to analyze the
collected data by using the statistical package program,
SPSS for Windows version 10.1. All statistical tests were
set at the level of significance of 0.05.
Descriptive Analysis
Descriptive statistics were performed to assess the

personality profiles of pharmacists in general as assessed
by the Five-Factor Model as well as all characteristics
(means, standard deviation, distribution) of other variables
in this study.
Reliability Analysis
The internal consistency of each measure such as

personality measure, pharmaceutical care behavior measure,
behavioral intention measure, attitude measure, subjective

norm measure, perceived behavioral control measure and
adequacy of resources measure were assessed from the data.
The internal consistency was assessed by calculating the
74
reliable coefficient Cronbach's alpha (Kerlinger, 1986).

Multiple correlations among variables were also performed to
record the evidence of collinearity.
Multiple Regression Analysis
Since each research question has one continuous
dependent variable and many continuous independent variables
and categorical independent variables (e.g. neuroticism,
extraversion, openness, agreeableness, conscientiousness,

attitude toward pharmaceutical care, subjective norm,
perceived behavioral control, and practice environmental
components), multiple regression analysis was performed.

However, gross violations of the assumptions of regression
analysis were first checked by assessing normality and
conducting a collinearity diagnostic test.

Multicollinearity problems can be detected by examining
the condition number from the diagnostic test results. A

high condition number indicates an ill-conditioned problem.
If a component associated with a high condition number

contributes strongly to the variance of two or more
variables, then a multicollinearity problem arises. When
the multicollinearity problem existed, data were
standardized before running the regression analysis.
Residual tests for gross violations of homoscedasticity

assumptions were also conducted. For each of the regression
models, the relationship between a dependent variable and
75
independent variables was assumed to be a linear relation.

The statistical method used for answering the research
questions is discussed next.

The first research question in this study was
RQ1: Does the personality of pharmacists

significantly contribute to the explanation of
behavior in pharmaceutical care provision,
controlling for practice environment?
The first hypothesis was generated from this research
question as
HI: extraversion score, openness score,

agreeableness score, and conscientiousness score
will have regression coefficients significantly
greater than zero in explaining the amount of
variation in the score of pharmaceutical care
provision, and neuroticism score will have a
regression coefficient significantly less than
zero in explaining the amount of variation in the
score of pharmaceutical care provision,
controlling for workload score, type of practice
setting, and adequacy of resources score.
This hypothesis was tested by using multiple regression
analysis. The statistical model for evaluating this
hypothesis is shown in the equation below:
PC = a +biNeuro +b2Extra +b30pen +b4Agree +bsConsci

+ +beWork +b7Resour +b8Setl +bgSet2 +b10Set3
+bnSet4 +bi2Set5 +e
PC = Pharmaceutical care provision
Neuro = Neuroticism
Extra = Extraversion
Open = Openness
Agree = Agreeableness
Consci = Conscientiousness
Work = Workload
Resour = Adequacy of resources
Setl Set2 Set3 Set4 Set5 = Dummy variables
for the 6 types of practice
setting.
76
For the variable of type of practice setting, five

dummy variables were assigned because pharmacists were
directed to choose 6 types of practice setting in the
questionnaire. The hospital pharmacy was chosen as a

reference category in the analysis.
The second research question in this study was
RQ2: What variables among five basic structures of

personality and social cognition contained in the
Theory of Planned Behavior will directly determine
pharmacists' self reported intention and behavior
relative to pharmaceutical care, controlling for
practice environment?
There were 2 hypotheses (H2.1 and H2.2) generated from
this research question. Behavioral intention was a
dependent variable in the first hypothesis (H2.1). The five
factors of personality, attitude, subjective norm, and
perceived behavioral control were independent variables to
predict intention. The first hypothesis is presented below:
H 2.1:extraversion score, openness score,

agreeableness score, conscientiousness score,
neuroticism score, attitude score, subjective norm
score and perceived behavioral control score will
have significant regression coefficients in
explaining the amount of variation in the
behavioral intention score, controlling for
workload score, adequacy of resources score, and
type of practice setting.
Pharmaceutical care provision was a dependent variable
in the second hypothesis (H2.2). From the Theory of Planned
Behavior, attitude and subjective norm have no direct
effects on behavior, and they were not included in the model
to predict pharmaceutical care provision. Theoretically,
77
the five basic structures of personality, behavioral

intention, and perceived behavioral control directly affect
behavior. Therefore, they were independent variables to
predict pharmaceutical care provision. The second
hypothesis is presented below:
H 2.2:extraversion score, openness score,

agreeableness score, conscientiousness score,
neuroticism score, behavioral intention score and
perceived behavioral control score will have
significant regression coefficients in explaining
the amount of variation in the score of
pharmaceutical care provision, controlling for
workload score, adequacy of resources score, and
type of practice setting.
Multiple regression analysis was performed to
investigate these associations. The statistical models for
evaluating these two hypotheses are shown in the equation

below:
(2.1) Intention = a -t-biNeuro +baExtra +b30pen

+b4Agree +b5Consci +b6Att +b7Subj
tbePercon +b9Work +bioResour
tbnSetl +bi2Set2 +bi3Set3
+bi4Set4 +bi5Set5 + e
(2.2) PC = a +biNeuro +b2 Extra +b 3 0 pen +b4Agree

tbsConsci tbglnten +b7Percon +bsWork
+bgResour +bioSetl +bnSet2 +bi2Set3
+bi3Set4 +bi4Set5 + e

Inten = Behavioral intention
Neuro = Neuroticism
Extra =s Extraversion
Open = Openness
Att =- Attitude
Subj = Subjective Norm
Percon = Perceived Behavioral Control
Work = Workload
78

Setl, Set2, Set3, Set4, Set5 = Dummy
variables for the 6 types of
practice setting.
The third research question in this study was:
R Q 3 : Do the social-cognitive constructs

significantly mediate the relationship between
personality and behavior, controlling for the
practice environment?
To test the mediational role of social cognition
between personality and behavior, this study was focused
specifically on the predicted role of behavioral intention
as a mediator in the association between the basic five
structures of personality and behavior relative to
pharmaceutical care. If any of these five basic structures
of personality had a significant relationship with
behavioral intention, then the mediational analysis was

conducted. The hypothesis associated with the mediational
analysis was generated from the third research question as:
H3: Behavioral intention score would serve as

significant mediator in the association between
extraversion score, openness score, agreeableness
score, conscientiousness score, and neuroticism
score and the score of pharmaceutical care
provision.
The method chosen to assess mediation in this study was
to follow three steps (Baron and Kenney, 1986; Judd and

Kenny, 1981). These steps included 1) the extent to which
personality affects the behavior is determined, 2) effects
of personality on hypothesized mediating variable are
evaluated, 3) the effects of hypothesized mediating variable
79
on behavior adjusted for the personality are determined. If

there is evidence that personality causes behavioral
intention and behavioral intention causes behavior, there is
evidence for mediation.
A mediational analysis may result in biased estimates
because of omitted variables that cause both the outcome and

the mediating variable. To reduce biased estimates,
variables that affected the behavior and intention were
controlled in the analysis. Beside the environmental
factors, perceived behavioral control was also added in all
regression equations as a control variable since,

theoretically, perceived behavioral control has direct
effects on both behavioral intention and behavior.

To test mediation effects, a series of regression
models were estimated in the way suggested by Baron and
Kenny (1986). Three regression equations were estimated.
1. Regressing the potential mediator on the personality
variable scores controlling for the practice environmental

factors and perceived behavioral control. The statistical
model is displayed below:
Intention = a +biNeuro +b2 Extra +b3 0 pen +b4Agree

+bsConsci +bsPBC +b 7 Work +b8Resour
+bgSetl +bioSet2 +bnSet3 +bi2Set4
+bi3Set5 +e
Intention = Behavioral intention

Neuro = Neuroticism
Open = Openness
80
PBC = Perceived behavioral control
Work = Workload
practice setting.
2. Regressing the pharmaceutical care score on both
personality variable scores and on the mediator controlling
for the practice environmental factors and perceived
behavioral control. The statistical model is shown below:
PC = a +biNeuro +b2Extra + b 3 0 p e n +b4Agree +bsConsci

+bgPBC +b 7W o r k +bsResour +bgSetl +bioSet2
+ b n S e t 3 +bi2Set4 +bi3Set5 +bi4Intention +e

Intention = Behavioral intention
Neuro = Neuroticism
Open = Openness
Work = Workload
practice setting.
3. Regressing the pharmaceutical care score on
personality variable score controlling for the practice
environmental factors and perceived behavioral control. The
statistical model is presented below:
PC = a +b]Neuro +b2Extra +b 3 0 pen +b4Agree +bsConsci

+b6PBC +b7Work +b8Resour +bgSetl +bioSet2
+bnSet3 +bi2Set4 +bi3Set5 + e

Neuro = Neuroticism
Open = Openness
81
Work = Workload
practice setting.
For the mediational model, three regression equations
were estimated: 1) regressing the potential mediator on the
personality variables; 2) regressing behavior variable on
both personality variables and on the mediator; and 3)

regressing behavior variable on personality variables. The
basic model involved in mediation is diagrammed in Figure 8.
Mediator
(Behavioral Intention)
Independent Dependent
Variable Variable
(Personality) (behavior)
Figure 8: General Mediational Model
As addressed by Baron and Kenny (1986), a variable
functions as a mediator when it meets the following
conditions: a) variations in levels of independent variable

significantly account for variations in the presumed
mediator (path a); b) variations in the mediator
82
significantly account for variations in the dependent

variable (path b) ; and c) when path a and b are controlled,
a previously significant relation between the independent

and dependent variables (path c) has to be reduced
significantly or no longer be significant, with the
strongest effect of mediation occurring when path c is zero.

The strength of the mediation was determined by comparing
the magnitude of the effect of independent variables on
dependent variable when including the mediator, versus not
including the mediator. Therefore, to test mediation

effects, a series of regression models was estimated in the
way suggested by Baron and Kenny (1986). The strength of

the mediation was determined by comparing the magnitude of
the effect of personality variable scores on the
pharmaceutical care provision score when including the
mediator versus not including the mediator.
83
CHAPTER IV
RESULTS
Cross-sectional survey data were collected from

pharmacists living in Iowa to: (1) investigate the
personality of pharmacists as assessed by the five-factor
model in predicting pharmacists' behavior relative to

pharmaceutical care, controlling for the practice
environments; (2) test a theoretical model that integrates
personality as assessed by the five-factor model and social-
cognitive constructs contained within the Theory of Planned
Behavior to predict behavioral intention and behavior in
providing pharmaceutical care; and (3) examine the
mediational effect of behavioral intention that links

between basic personality structures and behavior.
This chapter presents the results of statistical
analysis from this study. The first part of this chapter

presents descriptive statistical data including the response
rate, the respondents' demographic characteristics, study
variables characteristics and personality profile. The
second part presents the correlations among study variables

and scale reliabilities. The third part presents the
multiple regression analysis results of the first research
question of this study. The fourth part presents multiple
84
regression analysis results of the second research question

to identify factors that directly determine pharmacists'
self-reported behavioral intention and behavior relative to
pharmaceutical care. The fifth part presents the

mediational analysis results of the third research question,
which involved a series of regression models. The last part
presents some post hoc analyses.
Descriptive Statistics
Response Rate
Surveys were mailed to 600 pharmacists living in Iowa.
There were 33 nondeliverable surveys. Therefore, the

adjusted sample size was 567. From the 567 pharmacists in
the sample, 404 surveys were returned. This yielded the

response rate of 71.25 percent.
Of the 404 responses, 54 were unusable, and 9 were
returned after April 15, 2001. Therefore, 341 usable
surveys were obtained, and the usable response rate was
60.14 percent.
Demographic Characteristics
The practice characteristics of the respondents are
presented in Table 17. The majority of respondents were

community pharmacists. Almost half of respondents were
staff pharmacists and one-third of them were in management
position. Thirty-five pharmacists were retired, one
85
pharmacist refused to respond, one was deceased, one was

physically and mentally disabled, and eighteen pharmacists
were not practicing. They were excluded from the analysis.
Table 17. Pharmacists' Practice Characteristics
Practice Characteristic n1 % Mean

(S.D)
Current Practice Type 340 100
Community pharmacy (indep. /small 114 33.5
chain)
Community pharmacy (chain,>10 106 31.2
units)
Clinic pharmacy 12 3.5
Hospital pharmacy 65 19.1
Nursing home/Long term care 3 .9
Other 40 11.8
Current position 340 100
Manager or director 120 35.2
Assistant/Associate manager or 10 2.9
director
Supervisor 12 3.5
Staff/Employee pharmacist 159 46. 6
Other 39 11.4
Ownership (equity) in business 26. 95
(40.16)
n1 : Not include missing data
86
Table 18. Number of Prescriptions, Patients, and Beds of

each Setting
Settings n1 Number of prescriptions/day a, Number

of beds b, Number of patients/day c
Means S.D. Range
All Community 206 195.47 a 152.49 30-1500
pharmacy
indep. /small 95 167.29 a 122.62 45-1000

chain
chain, >10 100 207.49 a 166.86 30-1500
units
clinic 11 329.55 a 176.03 60-800
pharmacy
Hospital pharmacy 55 290.60 b 227.63 25-831
Nursing home/Long 3 401.67 c 359.94 20-735

term care
Sample size (n1) : does not include missing data
The average number of prescriptions per day filled by
clinic pharmacies was more than chain pharmacies with more

than 10 units, and more than independent or small chain
pharmacies. Ranges of number of prescriptions, patients per
day, and number of beds in each employment setting are

Table 19 provides the pharmacists'' demographic
characteristics. The number of male pharmacists was higher

than female pharmacists. The range of respondents' age was
Table 19. Pharmacist Demographic Characteristics
Demographic Characteristics Percent Mean (S.D.)

Age 45.16 (12.30)
Gender
Male 52.9
Female 47.1
Race
White/Caucasian 98.2
Black/African American 0.3
Oriental/Asian 1.2
Other 0.3
Degree earned
BS 89.4
PharmD (1st degree) 7.4
PharmD (post B.S.) 4.7
Pharmacy Residency 2.6
MS 2.1
MBA 2.4
PhD 0.6
Other 4.7
Number of years after first licensed as 20.13 (12.38)

a pharmacist
Marital Status
Single (never married) 7.4
Single (separated/divorced) 4 .4
Married 86.4
Widowed 1.8
88
25 to 85 years. The majority were White/Caucasian. Almost

all respondents possessed a bachelor of science in pharmacy
degree. The average number of years after respondents was
first licensed as a pharmacist was 20.13 years. The
majority of the respondents were married.
Characteristics of Study Variables
Personality Characteristics
Pharmacists' personalities as assessed by the Five-
Factor Model are presented in Table 20. Higher scores in
extraversion, neuroticism, agreeableness, openness, and

conscientiousness represented greater degrees of those
characteristics. Overall, pharmacists had the highest score
on the personality dimension of conscientiousness, followed
by agreeableness, openness, and extraversion, and had the
lowest score on neuroticism. Additional descriptive

statistics for individual items of the personality measure
(BFI) are presented in Appendix A.
The pharmacist personality profile is presented in
Figure 9 with the comparison to population norm personality
profile (Gosling, Potter, 2001) by the five factors of
personality. Pharmacists from our sample have higher scores

on extraversion, agreeableness, and conscientiousness but
lower scores on openness and neuroticism than the population
norm.
89
Table 20. Pharmacists' Personality Characteristics

Overall Scores
Personality Dimension N Mean S.D. Range
Extraversion 341 3.40 0.700 1.38-5.00

Neuroticism 341 2.50 0.595 1.00-4.25
Agreeableness 341 4.04 0.449 2.44-5.00
Openness 341 3.46 0.527 1.50-5.00
Conscientiousness 341 4.17 0.461 2.22-5.00
Personality Profile of Pharmacist and Population Norm
3.5
Scile Score
2 .5 -{
1.5 ■
-RxFemale j
-RxMaJe !
Female j
-Male
0 .5 -j
Extraversion Agreeableness Conscientiousness Neuroticism Openness

P ersonality Dim ension
Figure 9. Personality Profile of Pharmacist

Compared to the Population Norm
90
Table 21 presents mean scores of five dimensions of

personality by gender in pharmacists compared to the
population norm by gender (Gosling and Potter, 2001), t
statistic, and Cohen's d. To know the magnitude of the
effect of the independent variables (2 groups: pharmacist
Table 21. Pharmacists' Personality Characteristics Compared

to Population Norm
Pharmacist Population
(age 25-85) (age 25-65)a t d
Mean S.D. Mean S.D.
Extraversion Female 3.40 .72 3.25 .89 -2.09 -0.17
Male 3.39 .68 3.12 .89 -4.22 -0.31
Agreeableness Female 4.04 .47 3.86 .66 -3.52 -0.28
Male 4.03 .43 3.67 .73 -6. 64 -0.50
Conscientiousness Female 4.29 .40 3.77 .70 -9.25 -0.73
cn
00
1
Male 4.07 .49 3.64 .73 -0.59
Neuroticism Female 2.56 .61 3.09 .87 7. 60 0.60
Male 2.45 .58 2.80 .88 5.40 0.40
Openness Female 3.39 .54 3.89 .69 9.06 0.72
Male 3.53 .51 3.97 .66 9.09 0.68
a: Data source from Gosling, S.D.; Potter, J. (2001) The University of

Texas, Austin.
Sample size: Population (Female=51,869, Male=42,964)

Pharmacist (Female = 160, Male=180)
t = t statistic
d = the effect size index for t test of means in standard unit
91
and population) on the dependent variable (personality

score) , the effect size correlation that calculated from the
value of the t-test and its associated degrees of freedom
was used. Cohen's d is one useful measure of the effect
size (Rosnow, Rosenthal, and Rubin, 2000). It is the effect
size index for t tests of means in standard unit (Cohen,

1977) .
In social science, conventional values offered by Cohen

(1977) describe a small effect size when d equals 0.2, a
medium effect size when d equals 0.05, and a large effect
size when d equals 0.8. Data of Cohen's d values in Table
21 showed that there were substantial effect sizes. This

indicated that there were meaningful and reliable
differences between the personality profiles of pharmacists
compared to the population.
Social Cognitive and Behavioral
Variables Characteristics
Mean scale scores for the social cognition constructs
contained in the Theory of Planned Behavior and Behavioral

scale are summarized in Table 22. The descriptive
statistics for individual items of the attitude toward
pharmaceutical care measure, the social norm measure, the

perceived behavioral control measure, the behavioral
intention measure, and the pharmaceutical care measure are
presented in Appendix A.
92
Table 22. Social Cognitive and Behavioral Variables

Characteristics
Variables N Mean S.D. Range
Attitude toward pharmaceutical care3 314 14.11 4.43 1-21
Subjective Norm3 312 14.06 4.45 1-21
Perceived behavioral control3 313 12.63 4. 65 2-21
Behavioral intention3 313 13.56 4.81 1-21
Pharmaceutical care provision13 315 27.74 12.78 0-55
a scale: 1-21
b scale: 0-55
Environmental Components Characteristics
Table 23 presents the characteristics of the
environmental components in this study. Workload was
estimated by the average number of prescriptions pharmacists
were personally involved with per hour in a day. The mean

from all respondents (not included missing data) was found
to be 11.8 6 prescriptions per hour. The mode was 12.50
prescriptions per hour and median was 10.71 prescriptions
per hour.
Adequacy of resources was treated as a continuous
variable for the regression analysis. The low scores
reflected the low level of adequacy of resources for
pharmaceutical care provision. On a scale of 1 to 6, 1
93
represented very poor, 2 represented poor, 3 represented

fair, 4 represented good, 5 represented very good, and 6
represented excellent. The adequacy of resource score was

the sum of four items, which ranged from 1 to 24. The mean
was found to be 14.28. The mode was 15.00 and median was
14.00. Additional descriptive statistics for individual

items of the adequacy of resources measure are presented in
Appendix A.
The practice setting type was treated as a categorical

variable. There were 6 categories of types of practice
setting in the current study. The frequency analysis of
practice setting types was presented in Table 18.
Descriptive data of the other two environmental factors are

Table 23. Practice Environment Characteristics
Environmental Components N Mean S.D. Range
Workloadta) 279 11.86 8 .70 0-100
Adequacy of resources<bl 320 14.28 4 .38 2-24
a
scale: number of prescriptions per hour
scale: 1-24
94
Item Analysis and Scale Reliabilities

The inter-item correlations for each measure are
presented in Appendix B. Each of the individual items,
extraversion, neuroticism, agreeableness, openness,

conscientiousness, attitude toward pharmaceutical care,
subjective norm, perceived behavioral control, intention,
pharmaceutical care provision, and adequacy of resources
measure, was found to be significantly correlated among
items.
The internal consistency of each scale was assessed by
calculating the reliability coefficient Cronbach' s alpha
(Kerlinger, 1986). The reliability coefficient of the scale
measuring each key variable is presented in Table 24.
Correlations Among Variables

Pearson Correlation Coefficients were calculated to
evaluate the relationship between variables. A matrix of
Pearson correlation coefficient between the study variables
is presented in Table 25. The significant positive

correlations were found among extraversion, agreeableness,
conscientiousness, and openness but neuroticism had

significant negative correlation with the other four
dimensions of basic structures of personality. Extraversion
and openness had significant positive correlation with
pharmaceutical care provision. Extraversion,
95
Table 24. Reliability Coefficients for Measures
Measures Cronbach's alpha
Extraversion 0.8740
Neuroticism 0.7985
Agreeableness 0.7588
Openness 0.7960
Conscientiousness 0.7981
Pharmaceutical care provision (Direct 0.8524

patient care)
Attitude toward pharmaceutical care 0.7448
Social norm 0.8026
Perceived behavioral control 0.7453
Behavioral intention 0.7612
Workload -
Adequacy of resources 0.6651
Practice setting types -
agreeableness, and openness had a significant positive
correlation with intention to provide pharmaceutical care.
Only agreeableness had a significant positive correlation

with workload. Extraversion, agreeableness, and openness
had significant positive correlations with adequacy of
resources but neuroticism had a significant negative
correlation with adequacy of resources.
96
Significant positive correlations were also found among

social cognition constructs — attitude toward
pharmaceutical care, subjective norm, perceived behavioral

control, and behavioral intention. All of the social
cognition constructs had significant positive correlations
with pharmaceutical care provision. There was no
significant correlation with workload among these social
cognitions, but there were positive correlations among the

social cognitions with adequacy of resources.
Attitude toward pharmaceutical care had significant
positive correlations with extraversion, agreeableness,
conscientiousness, and openness. Subjective norm had
positive correlations with extraversion and openness.

Perceived behavioral control had significant negative
correlations with neuroticism but had significant positive
correlations with the other four dimensions of personality.

Workload was not correlated with pharmaceutical care
provision. Adequacy of resources was significantly
correlated with pharmaceutical care provision.
The variable of practice setting type was a six-
category variable. Because of the frequency distribution,

this variable was reorganized into three groups, which were
community pharmacy, hospital pharmacy, and other setting,
and assigned value 1 for respondents who belonged to that
setting and 0 for respondents who did not belong to that
97
setting. In the case that one of the variables is

continuous while the other variable is dichotomous with
arbitrarily applied numerical values such as 0 and 1 a
point-biserial correlation (rpb), which is a special case of
the product-moment r, can be used to investigate their
correlation (Rosnow and Rosenthal, in press). However, the
point-biserial is merely the same thing as the standard
Pearson bivariate correlation coefficient (Rosnow and
Rosenthal, in press) since the Pearson correlation algorithm

degenerates to the point-biserial algorithm computation when
one of the variable is binary. Therefore, Pearson
correlation coefficient was used to investigate the
correlation among practice setting types with key variables.
Multiple Regression Analyses
Collinearity diagnostic tests were first checked for
detecting gross violations of the assumptions of regression
analysis. The variance inflation factor (VIF) is often used

to measure collinearity in a multiple regression analysis.
The larger the values of VIF, the more troublesome are the
independent variables. Some people prefer to consider
tolerance, which is the inverse value of VIF. A rule of
thumb for evaluating VIFs is to be concerned with any value
larger than 10.0 (Kleinbaum, Kupper, and Muller, 1987). All
hypothesized models had VIF values less than 3.
Table 25. Pearson Correlation Coefficient Matrix of All Study Key Variables
Variable 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1.Extraversion 1
2.Neuroticism -.30** 1
3.Aqreeableness .22“ -.43“ 1
4.Openness .32“ -.22“

ro
CO .13* 1
1
5.Conscientiousness .18** .32“ .17“ 1

6.Attitude .18“ -.07 .13* .23** .13* 1
7.Sub1ective norm .17“ -.04 .11 .17** .07 .76** 1
8.Perceived .20“ -.17“ .15“ .24** .12* .72** .66** 1
Behavioral
Control
9.Intention .21* * -.07 .17** .21“ .11 .86“ .76** .77** 1
10.Pharmaceutical .21“ -.09 .07 .23** .11 .64“ .56** .62“ .63** 1
Care Provision
UJ
1
11.Workload -.04 .12 .02 .10 .07 .04 .05 .05 .04
©
1
12.Adequacy of .25“ -.12* .18“ .22“ .09 .29** .30“ .42** .32“ .32“ -.01 1
resources
13.Community .12* -.05 .14** -.05 .11* -.01 -.09 .00 .01 -.17“ .17** .08 1
pharmacy
14.Hospital Pharmacy -.09 .04 -.10 .03 -.14* -.01 .07 -.04 -.01 .13* -.05 .09 -.71** 1
15.Other setting -.06 .02 -.08 .03 .02 .04 .05 .05 .00 .09 -.19“ .01 -.56** -.18“ 1
**p<0.01; *p<0.05
vo
oo
99
No formal criterion exists for establishing a critical

range for condition indices. It is common practice to
associate a condition index of 10 with the notion that weak
dependencies may be starting to affect the regression
estimates. Condition indices of 30 to 100 indicate moderate
to strong dependencies, and indices of greater than 100

indicate serious collinearity problems. Collinearity
diagnostic test results showed that none of the variables
had condition indices greater than 100, but there were two
variables in each model that had a condition index between
33-64. This indicates moderate dependencies, but not an
ill-conditioned problem.
Residual values were plotted versus predicted values
for each model. These scatterplots also indicated no signs
of nonconstant variance or nonlinearity.

The first hypothesis investigated the contribution of
personality of pharmacists in the explanation of their
behavior relative to pharmaceutical care. To test this
hypothesis, a multiple regression model with one dependent

and five independent variables and three control variables
was used. Since the type of practice setting was a
categorical variable, dummy variables were used in the
analysis, and hospital pharmacy setting was used as a
reference. The final model for this hypothesis is displayed
in Table 26.
100
Table 26. Multiple Regression Model Results: Hypothesis 1
Variable B SE P t Sig Collinearity

Statistics
Tolerance VIF
Constant -8.283 11.718 -.707 .480
(intercept)
Extraversion 1.748 1.110 .098 1.575 .116 .782 1.278
Neuroticism -.100 1.377 -.005 -.073 .942 .735 1.361
Openness 2.987 1.425 .127 2.096 .037 .833 1.200
Agreeableness .834 1. 923 .028 .434 .665 .712 1. 405
Conscientious 1.877 1.638 .068 1.146 .253 .854 1.170

ness
Workload .090 .082 .062 1.097 .274 .943 1. 060
Adequacy of .891 .172 .303 5.193 .000 .891 1.122

resources
Community -6.814 2.110 -.215 -3.230 .001 .683 1. 4 64
pharmacy
Other setting -1.301 3.350 -.026 -.388 .698 .697 1. 434
Model R2 = 0.205; Adjusted R2 = 0.178

F = 7.513, 9 and 262 df, p = .000, n = 271
Dependent variable: Pharmaceutical care provision
Overall these five dimensions of personality and
control variables explained 20.5% of the variation in
pharmaceutical care provision. The estimates of the model
coefficients showed that openness was significantly related
with pharmaceutical care provision, but the other four
personality variables were not significantly related with
101
pharmaceutical care provision, when controlling for practice

environmental factors. Two practice environmental factors
that were found to contribute significantly to
pharmaceutical care provision were the adequacy of resources

and the types of practice setting.
Analysis of Theoretical Model

Two regression models were generated from the second
hypothesis to identify factors among personality and social

cognitions which directly influenced pharmacists' self-
reported intention and pharmaceutical care provision.
The first model was used to predict behavioral intention and
is shown in Table 27. Behavioral intention was regressed on
neuroticism, extraversion, openness, agreeableness,

conscientiousness, attitude toward pharmaceutical care,
subjective norm, perceived behavioral control, and control
variables. This model could explain 78% of the variation of
behavioral intention. The variables found to significantly
determine behavioral intention were agreeableness, attitude

toward pharmaceutical care, subjective norm, and perceived
behavioral control. Regression coefficients for the other
four basic structures of personality were not significant.
The most important predictor of behavioral intention was
attitude toward pharmaceutical care. The next important
predictor was perceived behavioral control. None of control
variables had significant regression coefficients.
102
Table 27. Multiple Regression Model for Predicting

Behavioral Intention: Hypothesis 2.1

Statistics
Tolerance VIF
Constant -4.374 2.307 -1.896 .059
(intercept)
Extraversion .166 .220 .024 .757 .450 .775 1.290
Neuroticism .432 .277 .052 1.558 .120 .712 1.404
Openness -.197 .285 -.022 -.692 .489 .802 1.248
Agreeableness .941 .379 .083 2.485 .014 .716 1.396
Conscientious -.328 .326 -.031 -1.007 .315 .849 1.179

ness
Attitude .585 .053 .530 10.974 .000 .347 2.885
Subjective .191 .048 .178 3.993 .000 .406 2.4 65

Norm
Perceived .288 .047 .275 6.099 .000 .396 2.523
Behavioral
Control
Workload -.063 .016 -.011 -.391 .696 .937 1.068
Adequacy of -0.021 .037 -.019 -.584 .560 .752 1.330

resources
Community .405 .424 .033 .954 .341 .668 1.496
pharmacy
(indep./small
chain)
Other setting -.324 .681 -.016 -.475 .635 .682 1. 466

F = 81.695, 12 and 257 df, p = .000, n = 269
Dependent variable: Behavioral intention
103
To identify factors among personality and social

cognitions which directly influenced pharmacists' self-
reported behavior relative to pharmaceutical care,
pharmaceutical care provision was regressed on neuroticism,
extraversion, openness, agreeableness, conscientiousness,

behavioral intention, perceived behavioral control, and
control variables. The regression model is shown in Table
28. None of the five basic structures of personality were
found to be significant predictors of behavior relative to

pharmaceutical care. The variables found to significantly
determine behavior relative to pharmaceutical care were
perceived behavioral control and behavioral intention. The
most important predictor of pharmaceutical care provision
was behavioral intention. The next important predictor was
perceived behavioral control. Two control variables found to

have significant regression coefficients were adequacy of
resources and types of practice setting.
Mediational Analysis
The third hypothesis investigated how the social-
cognitive constructs contained within the Theory of Planned

Behavior may mediate between the pharmacists' personality
and their behavior in providing pharmaceutical care. The
current study was focused specifically on the predicted role
of behavioral intention as a mediator in the predicted
104
association between the five factors of personality and

pharmaceutical care behavior.
Table 28. Multiple Regression Model for Predicting

Pharmaceutical Care Provision: Hypothesis 2.2

Statistics
Tolerance VIF
Constant -6.440 9.674 -. 666 .506
(intercept)
Extraversion 1.359 .917 .076 1.482 .139 .771 1.297
Neuroticism .195 1.158 .009 .169 .866 .697 1.434
Openness .997 1.182 .042 .844 .399 .812 1.231
Agreeableness -.816 1.598 -.028 -.511 .610 .693 1.443
Conscientiousn 1.904 1.348 .069 1.412 .159 .849 1.177

ess
Intention .931 .185 .356 5.022 .000 .408 2.449
Perceived .693 .206 .253 3.366 .001 .361 2.769

Behavioral
Control
Workload 0.045 .067 .031 .674 .501 .942 1.062
Adequacy of .324 .153 .110 2.119 .035 .755 1.325

resources
community -7.194 1.750 -.226 -4.110 .000 .675 1.481
pharmacy
other setting -3.089 2.778 -.061 -1.112 .267 .680 1.471

F = 16.2, H a n d 259 df, p = .000, n = 270
105
Mediator Effect of Behavioral Intention

The mediational model examined the potential role of
behavioral intention as a mediator in the relationship
between extraversion, neuroticism, agreeableness, openness,
and conscientiousness, and pharmaceutical care provision.
To reduce biased estimates of mediation process, variables
that affect behavior and intention were controlled.
Practice environmental factors and perceived behavioral
control, theoretically, have direct effects on behavior and

behavioral intention. They were included as control
variables in all regression equations that were used to test

the mediational effect.
The regression analysis results are presented in Tables
29, 30, and 31. The results showed that agreeableness,

neuroticism, and perceived behavioral control significantly
account for variations in behavioral intention (R2 = 0.592,
F (10, 260) = 37.661, p =.000). Extraversion, perceived

behavioral control, and types of practice setting
significantly accounted for variations in pharmaceutical

care provision (R2 = 0.418, F (10, 260) = 18.664, p =.000),
and when behavioral intention was controlled, the previously
significant relationship between extraversion and
pharmaceutical care provision no longer existed (R2 = 0.470,
F (11, 259)= 20.841, p =.000).
106
As summarized in Table 32, overall, the standardized

regression coefficient of all personality dimensions
decreased when behavioral intention was controlled. The

standardized regression coefficient of extraversion was
reduced from 0.106 to 0.07 6 and the significant relation
between extraversion and pharmaceutical care provision was
no longer significant when behavioral intention was
controlled. However, extraversion was not significantly

related to behavioral intention. Thus, it could not be
concluded that behavioral intention was the mediator between
extraversion and pharmaceutical care provision when
controlling for practice environmental factors and perceived
behavioral control. Figure 10 presents the results
graphically from the mediational analysis.
107
Table 29. Results of Regression Model 1: Mediational

Analysis

Statistics
Tolerance VIF
Constant -6.137 3.215 -1.909 .057
(intercept)
Extraversion .558 .305 .082 1.831 .068 .781 1.280
Neuroticism 1.180 .381 .144 3.100 .002 .723 1.383
Openness 0.079 .396 .009 .199 .842 .812 1.231
Agreeableness 1.318 .528 .117 2.495 .013 .710 1.409
Conscientious 0.050 .451 .000 .011 .991 .849 1.177

ness
Perceived .799 .048 .765 16.684 .000 .748 1.337
behavioral
control
Workload 0.015 .023 .003 .0 68 .946 .942 1.062
Adequacy of -0.039 .051 -.035 -.7 67 .444 .757 1.322

resources
Community -.331 .585 -.027 -.565 .573 .676 1.479
pharmacy
Other setting -1.240 .927 -.064 -1.339 .182 .685 1.461

F = 37.661, 10 and 260 df, p = .000, n = 270
108

Analysis

Statistics
Tolerance VIF
Constant -6.440 9. 674 -.666 .506
(intercept)
Extraversion 1.359 .917 .076 1.482 .139 .771 1.297
Neuroticism .195 1.158 .009 .169 .866 .697 1. 434
Openness .997 1.182 .042 .844 .399 .812 1.231
Agreeableness -.816 1.598 -.028 -.511 .610 .693 1.443
Conscientious 1.904 1.348 .069 1.412 .159 .849 1.177

ness
Intention .931 .185 .356 5.022 .000 .408 2.449
Perceived .693 .206 .253 3.366 .001 .361 2.769

behavioral
control
Workload 0.045 .067 .031 .674 .501 .942 1.062
Adequacy of .324 .153 .110 2.119 .035 .755 1.325

resources
Community -7.194 1.750 -.226 -4.110 .000 .675 1.481
pharmacy
Other setting -3.089 2.778 -.061 -1.112 .267 .680 1.471

F = 20.841, 11 and 259 df, p = .000, n = 270
109

Analysis

Statistics
Tolerance VIF
Constant -12.151 10.045 -1.210 .228
(intercept)
Extxaversion 1.878 .952 .106 1.972 .050 .781 1.280
Neuroticism 1.293 1.189 .061 1.088 .278 .723 1.383
Openness 1.071 1.236 .046 .867 .387 .812 1.231
Agreeableness .410 1.651 .014 .249 .804 .710 1.409
Conscientious 1.908 1.409 .070 1.354 .177 .849 1.177

ness
Perceived 1.437 .150 .525 9.602 .000 .748 1.337
behavioral
control
Workload 0.046 .070 .032 .665 .507 .942 1.062
Adequacy of .287 .160 .098 1.801 .073 .757 1.322

resources
Community -7.502 1.829 -.236 -4.102 .000 .676 1.479
pharmacy
Other setting -4.243 2.895 -.084 -1.466 .144 .685 1.4 61

F = 18.664, 10 and 260 df, p = .000, n = 270
R eproduced with permission of the copyright owner. Further reproduction prohibited without permission.
110
Table 32. Regression Coefficient of Each Personality

Dimension Before and After Including
Mediator
Regression Coefficient(P)
without behavioral with behavioral
intention intention
B 3 B 3
Extraversion 1.878* .106* 1.359 .076
Neuroticism 1.293 .061 .195 .009
Openness 1.071 .046 .997 .042
Agreeableness .410 .014 -.816 -.028
Conscientiousness 1.908 .070 1.904 .069
* p < 0.005
Agreeableness Neuroticism Extraversion
P= 0.117 P= 0.144 P= 0.106'
Intention P= 0.356' Pharmaceutical

Care Provision
Perceived
Behavioral
Control
-Practice Setting
-Workload
Figure 10. Results Diagram of Hypothesis 3
Ill
Post Hoc Analyses
Predictive Model
from All Key Variables
To explore how all key variables in this study can
together predict pharmaceutical care provision,

pharmaceutical care provision was regressed on all key
variables — extraversion, neuroticism, openness,
agreeableness, conscientiousness, attitude toward
pharmaceutical care, subjective norm, perceived behavioral

control, and intention, controlling for practice
environmental factors. The variables found to significantly

predict pharmaceutical care provision were attitude toward
pharmaceutical care and perceived behavioral control. Two

control variables also found to have significant association
with pharmaceutical care provision were adequacy of

resources and practice setting types. The results from
multiple regression model are presented in Table 33.

Because many variables were intercorrelated, it is
useful to select a smaller set of predictors that will be as
efficient or nearly as efficient, as the entire set for the
predictive purposes. One common approach to select a subset
of variables from a complex model is stepwise regression. A
stepwise regression is a procedure to examine the impact of
112
Table 33. Multiple Regression Model Results from Post Hoc

Analysis (Model for Predicting Pharmaceutical
Care Provision)

Statistics
Tolerance VIF
Constant -7.482 9.551 -.783 .434
(intercept)
Extraversion 1.217 .905 .068 1.345 .180 .773 1.293
Neuroticism 0.079 1.146 .004 .070 .945 .705 1.418
Openness .712 1.171 .030 .608 .544 .800 1.250
Agreeableness -.475 1.576 -.016 -.301 .763 .699 1.430
Conscientious 1.371 1.343 .050 1.021 .308 .845 1.183

ness
Attitude .800 .266 .277 3.011 .003 .236 4 .237
Subj ective .121 .203 .043 .598 .550 .382 2.618

Norm
Perceived .554 .208 .202 2.668 .008 .346 2.889
Behavioral
Control
Intention .330 .256 .126 1.289 .199 .208 4 .815
Workload 0.039 .067 .027 .590 .556 .936 1.068
Adequacy of .330 .151 .113 2.190 .029 .751 1.331

resources
Community -6.602 1.747 -.207 -3.779 .000 .666 1.502
pharmacy
Other setting -2.425 2.803 -.047 -.8 65 .388 .682 1.467
Model R2 = .490; Adjusted R2 = .464

F = 18.908, 13 and 256 df, p = .000, n = 269
113
each variable on the model step by step. The variables that

do not contribute much to the variance explanation are then
discarded. Stepwise regression was utilized in the post hoc
analysis to determine the order of predictors by its
magnitude of influence on the pharmaceutical care provision.
The final model from the stepwise selection is presented in
Table 34. The reduced model (R2 = 0.47) addressed above
yielded almost about the same R2 as the full model (R2 =

0.49).
Table 34. Regression Coefficients of Stepwise Model: Post

Hoc Analysis
Model B SE P t Sig. Collinearity

Statistics
Tolerance VIF
(Constant) 1.218 2.599 .469 .640
Attitude 1.175 .182 .406 6.470 .000 .503 1.988
Perceived .674 .183 .246 3.690 .000 .446 2.241

behavioral
control
Adequacy of .375 .146 .128 2.576 .011 .800 1.250
resources
Community -5.390 1.428 -.169 -3.775 .000 .993 1.007
pharmacy
Model R2 = 0.474
Adjusted R2 = 0.4 66
F = 59.705, 3 and 266 df, p = .000, n = 269
114
Full Model
with Pharmacist Demographics
To explore the contribution of pharmacist demographics
in pharmaceutical care provision, pharmacist demographic
variables — number of years licensed as a pharmacist,
gender, degree earned, and current position — were added

into the full model with all of the key variables. The
practice environmental factors — workload, adequacy of

resources, and types of practice setting — were put in the
first block in the regression analysis as control variables,
followed by all nine key variables which were extraversion,
neuroticism, openness, agreeableness, conscientiousness,

attitude toward pharmaceutical care, subjective norm,
perceived behavioral control, and behavioral intention into
the second block of the regression analysis. Pharmacist

demographic variables were added into the third block.
Because of the frequency distribution, current position

was recategorized into 3 groups which were 1) manager or
director, assistant/associate manager or director, and
supervisor, 2) staff/employee pharmacist, and 3) other. Two
dummy variables, therefore, were assigned for the current
position variable. Since pharmacists can possess more than
one earned degree, the variable of degree earned was recoded
into two variables as whether or not the respondent

possesses 1) BS degree and 2) other degree including: PharmD
115
(1st degree), PharmD (post B.S.), Pharmacy Residency, MS,

MBA,PhD, and "other".
The results of R2, R2 change, regression coefficient,

and significant value are presented in Tables 35 and 36.
Table 35. Summary of The Full Model with Pharmacist

Demographics
Model R R2 Adj usted Std. Change F dfl df2 Sig. F

R2 Error of Statistics Change Change
the (R2)
Estimate
a .412 .169 .157 11.60679 .169 13.459 4 264 .000
b .702 .492 .466 9.23356 .323 18.016 9 255 .000
c .719 .517 .480 9.11787 .024 2.085 6 249 .056
Model a Predictors: (Constant), other setting, adequacy of resources,

nursing home/long term care, clinic pharmacy, workload (Rx/Hour),
community pharmacy (chain, >10 units), community pharmacy (indep./small
chain)
Model b Predictors: (Constant), other setting, adequacy of resources,

chain), neuroticism, conscientiousness, openness, subjective norm,
extraversion, agreeableness, perceived behavioral control , attitude,
intention
Model c Predictors: (Constant), other setting, adequacy of resources,

chain), neuroticism, conscientiousness, openness, subjective norm,
extraversion, agreeableness, perceived behavioral control , attitude,
intention, MBA degree, BS degree, pharmacy residency, PhD degree, other
position, other degree, gender, PharmD (post B.S.), manager or
director/assistant/associate/supervisor, MS degree, number of years
licensed as a pharmacist, PharmD (1st degree)
116
Table 36. Regression Coefficients of Variables in The Full

Model with Pharmacist Demographics
B SE P t Sig. Collinearity
Statistics
Tolerance VIF
(Constant) -11.759 9.938 -1.183 .238
Workload (Rx/Hour) 0.056 .067 .039 .848 .398 .902 1.109
Adequacy of .301 .152 .103 1.975 .049 .719 1.390

resources
Community pharmacy -6.431 1.775 -.201 -3.623 .000 .629 1.590
Other setting -3.532 2.837 -.068 -1.245 .214 .649 1.542
Extraversion 1.182 .894 .066 1.322 .187 .772 1.295
Agreeableness -.500 1.564 -.017 -.320 .749 .693 1.442
Conscientiousness 1.350 1.399 .049 .965 .335 .760 1.316
Neuroticism .305 1.159 .014 .263 .793 .673 1. 485
Openness .863 1.181 .037 .731 .466 .770 1.299
Attitude .802 .265 .277 3.026 .003 .231 4.328
Subjective norm .163 .205 .058 .793 .428 .365 2.742
Perceived .525 .207 .192 2.541 .012 .341 2. 932

behavioral control
Intention .312 .259 .119 1.204 .230 .198 5.044
Number of years .106 .058 .100 1.824 .069 .641 1.559

licensed as a
pharmacist
Gender 1.767 1.399 .070 1.263 .208 .633 1.580
Manager or .760 1.262 .030 .602 .548 .786 1.273

director/assistant
/associate/
supervisor
117
Table 36. -continued
B SE P t Sig. Collinearity
Statistics
Tolerance VIF
Other position 4.192 2.291 .089 1.830 .068 1.222
.818
BS degree -.670 2.555 -.017 -.262 .793 .478 2.093
Whether or not 3.304 1.985 .104 1. 664 .097 .496 2.018

they have other
degree
F = 14.002, 19 and 249 df, p = .000, n = 268
When adding pharmacist demographics into the model, R2
increased 2.4% but the F statistic of R2 change was not

significant. Two key variables, which were attitude toward
pharmaceutical care and perceived behavioral control, still
had significant associations with pharmaceutical care
provision. Type of practice setting had a significant
relationship with pharmaceutical care provision. No
pharmacist demographic variables had significant
relationships with pharmaceutical care provision.
118
Mediator Between
Openness and
The result from the first research question in the
present study ("Does the personality of pharmacists
significantly contribute to the explanation of behavior
relative to pharmaceutical care, controlling for the
practice environment?") showed that only one personality
dimension, openness, had a significant positive association
with pharmaceutical care provision. Post hoc analysis also

explored whether behavioral intention could mediate between
openness and pharmaceutical care when controlling for only
practice environmental factors as in the hypothesis one, not

controlling for perceived behavioral control.
The regression analysis results from all three
equations are presented in Tables 37, 38, and 39. The
results showed that openness and adequacy of resources
significantly accounted for variations in behavioral
intention (R2 = 0.154, F (9, 261) = 5.293, p =.000).

Openness, adequacy of resources, and types of practice
setting significantly accounted for variations in
pharmaceutical care provision (R2 = 0.211, F (9, 261) =
7.776, p =.000). When behavioral intention was controlled,
the previously significant relationship between openness and
pharmaceutical care provision was no longer significant (R2
119
Table 37 Results of Regression Model 1: Mediational

Analysis (Post Hoc Analysis)

Statistics
Tolerance VIF
Constant -3.685 4.613 -.799 .425
(intercept)
Extraversion .565 .438 .083 1.291 .198 .781 1.280
Neuroticism .370 .542 .045 .683 .495 .735 1.361
Openness 1.125 .561 .125 2.006 .046 .833 1.200
Agreeableness 1.393 .759 .124 1.835 .068 .710 1.409
Conscientious .162 .648 .015 .249 .803 .850 1.177

ness
Workload 0.021 .032 .038 .645 .519 .944 1.059
Adequacy of .292 .068 .261 4.322 .000 .891 1.122

resources
Community -.317 .841 -.026 -.377 .707 .67 6 1.479
pharmacy
Other setting -0.073 1.327 .000 -.006 .996 .689 1.451

F = 5.293, 9 and 261 df, p = .000, n = 270
= 0.446, F (10, 260)= 20.959, p =.000). The variables that
significantly accounted for the variations in pharmaceutical
care provision were adequacy of resources, types of

practice, and behavioral intention. Figure 11 presents the
diagrammed result of the mediational effect of intention
120
between openness and pharmaceutical care provision, when not

controlled for perceived behavioral control.
Table 38 Results of Regression Model 2: Mediational


Statistics
Tolerance VIF
Constant -2.660 9.798 -.272 .786
(intercept)
Ext ravers ion 1.111 .932 .062 1.193 .234 .776 1.289
Neuroticism -.673 1.151 -.031 -.584 .559 .734 1.363
Openness 1.400 1.199 .060 1.168 .244 .821 1.219
Agreeableness -1.376 1.620 -.047 -.849 .396 .701 1.427
Conscientious 1. 967 1.374 .072 1.431 .154 .850 1.177

ness
Intention 1.379 .131 .527 10.502 .000 .846 1.183
Workload 0.052 .069 .037 .769 .443 .943 1.061
Adequacy of .480 .148 .164 3.235 .001 .832 1.202

resources
Community -7.040 1.784 -.222 -3.946 .000 .676 1.480
pharmacy
Other setting -2.016 2.814 -.040 -.716 .474 .689 1.451
Model R2 = 0.4 4 6; Adjusted R2 = 0.425

F = 20.959, 10 and 260 df, p = .000, n = 270
121


Statistics
Tolerance VIF
Constant -7.742 11.656 -.664 .507
(intercept)
Extraversion 1.891 1.106 .106 1.709 .089 .781 1.280
Neuroticism -.162 1.370 -.008 -.118 .906 .735 1.361
Openness 2. 952 1.417 .125 2.083 .038 .833 1.200
Agreeableness .544 1.918 .019 .284 .777 .710 1.409
Conscientious 2.190 1.637 .080 1.338 .182 .850 1.177

ness
Workload 0.081 .082 .056 .998 .319 .944 1.059
Adequacy of .883 .171 .301 5.170 .000 .891 1.122

resources
Community -7.477 2.125 -.235 -3.519 .001 .676 1.479
pharmacy
Other setting -2.026 3.352 -.040 -.605 .546 .689 1.451

F = 7.776, 9 and 261 df, p = .000, n = 270
122
Table 40. Regression Coefficient of Each Personality

Mediator (Post Hoc Analysis)
Regression Coefficient (3)

Without behavioral With behavioral
intention intention
B 3 B 3
Extraversion 1.891 .106 1.111 .062
Neuroticism -.162 -.008 -.673 -.031
Openness 2.952* .125* 1.400 .060
Agreeableness .544 .019 -1.376 -.047
Conscientiousness 2.190 .080 1.967 .072
* p < 0.005
Behavioral
Intention
P=.125* (3=. 527*
Openness Pharmaceutical Care

Provision
P=.125* ----
(3=. 060 (with intention)
-Practice Setting
-Workload
* p<0.005
Figure 11. Diagram Results of Mediational Effect

of Intention Between Openness and
Pharmaceutical Care Provision (Does Not
Control for Perceived Behavioral Control)
123
Adding Pharmacist Demographics
as Control Variables in all Hypotheses

Beside environmental factors, pharmacist Demographics -
- number of years licensed as a pharmacist, gender, and

current position — were added in all hypothesis models in
post hoc analysis. Pharmacist's current position was
grouped into three categories because of the frequency
distribution. The first group was comprised of manager or

director/assistant/associate/supervisor. The second group
was staff and employee pharmacists. The last group was other
positions. Dummy variables were assigned to this variable
and the second group was chosen as a reference group in the

multiple analyses.
Table 41 presents the model from the first hypothesis
in the present study, which investigated the contribution of
personality to the explanation of pharmaceutical care
behavior, controlling for both environmental factors and
pharmacist demographics. Openness was still significantly

related with pharmaceutical care provision. The adequacy of
resources and the types of practice setting were two
environmental factors that were found to contribute
significantly to pharmaceutical care provision. The number
of years licensed as pharmacist and gender were not
significantly related with pharmaceutical care provision.
124
Table 41. Post Hoc Multiple Regression Model Results:

Hypothesis one (Adding Pharmacist Demographics as
control variables)

Statistics
Tolerance VIF
Constant 13.781 3.534 3.899 .000
(intercept)
Extraversion 1.672 1.092 .094 1.530 .127 .782 1.279
Neuroticism -0.078 1.383 -.004 -.057 .955 .706 1.417
Openness 3.468 1.415 .147 2.452 .015 .820 1.219
Agreeableness .560 1.901 .019 .295 .7 68 .706 1.417
Conscientious 1.731 1.704 .063 1.016 .310 .765 1.307
ness
Workload .132 .082 .091 1.615 .108 .918 1.090
Adequacy of .892 .171 .303 5.213 .000 .870 1.149
resources
Community -7.588 2.118 -.240 -3.583 .000 .656 1.525
pharmacy
Other setting -2.517 3.371 -.050 -.747 .456 .666 1.502
Number of years -0.051 .067 -.047 -.749 .455 .735 1.361
licensed as a
pharmacist
Gender 1. 602 1. 688 .063 .949 .343 .660 1.516
Manager or 3.306 1.511 .130 2.188 .030 .833 1.201
director/assis-
tant/associate/
supervisor
Other position 8.575 2.764 .181 3.102 .002 .859 1.164
Model R2 = 0.24 6; Adjusted R2 = 0 .208

F = 6.458, 13 and 257 df, p = .000, n = 270
125
The current position variable was found to contribute

significantly to pharmaceutical care provision.
Table 42 presents the model used to predict behavioral

intention, controlling for both environmental factors and
pharmacist demographics. The significant predictors
remained the same as when not controlling for pharmacist
demographics. However, two pharmacist demographic variables
that were found to be significantly related to intention
were gender and current position.
Table 42. Post Hoc Multiple Regression Model for Predicting

Behavioral Intention (Adding Pharmacist
Demographics as control variables in the Model for
predicting Intention)

Statistics
Tolerance VIF
Constant -4.876 2.345 -2.079 .039
(intercept)
Extraversion .155 .218 .023 .712 .477 .774 1.292
Neuroticism .446 .281 .054 1.590 .113 .680 1.470
Openness -.105 .285 -.012 -.369 .713 .783 1.277
Agreeableness .874 .377 .077 2.320 .021 .709 1.410
Conscientious -.412 .339 -.039 -1.212 .227 .766 1.305
ness
Attitude .573 .053 .520 10.760 .000 .339 2.948
Subjective .202 .048 .189 4.199 .000 .393 2. 547
Norm
Perceived .277 .047 .265 5.864 .000 .388 2.575
Behavioral
Control
126

Statistics
Tolerance VIF
Workload 0.015 .016 .003 .095 .925 .910 1.099
Adequacy of -0.023 .037 -.020 -.615 .539 .726 1.377
resources
Community .220 .427 .018 .515 .607 .644 1.554
pharmacy
(indep./small
chain)
Other setting -.497 .689 -.025 -.721 .472 .653 1.532
Number of years 0.015 .014 .038 1.138 .256 .698 1.433
licensed as a
pharmacist
Gender .67 6 .338 .070 2.003 .046 .644 1.552
Manager or .796 .303 .082 2.631 .009 .811 1.233
director/assis
tant/ associate/
supervisor
Other position .964 .554 .054 1.742 .083 .832 1.202
F = 97.244, 16 and 252 df, p = .000, n = 269
The model used to predict pharmaceutical care
provision, controlling for both environmental factors and
pharmacist demographics is presented in Table 43. The
significant predictors were the same as when not controlling

for pharmacists' demographics. None of the pharmacist
demographics was found to be significantly related with
127
Table 43. Post Hoc Multiple Regression Model for Predicting

Pharmaceutical Care Provision (Adding Pharmacist
Demographics as control variables)

Statistics
Tolerance VIF
Constant -8.962 9.946 -.901 .368
(intercept)
Extravers ion 1.336 .916 .075 1.458 .146 .770 1.298
Neuroticism .393 1.185 .018 .332 .740 .665 1.504
Openness 1.276 1.196 .054 1.067 .287 .794 1.259
Aqreeableness -.961 1.605 -.033 -.599 .550 .687 1.455
Conscientious 1.908 1.421 .069 1.342 .181 .763 1.311
ness
Intention .921 .189 .352 4.877 .000 .393 2.546
Perceived .685 .208 .250 3. 302 .001 .355 2.815
Behavioral
Control
Workload 0.066 .068 .046 .970 .333 .913 1.096
Adequacy of .327 .156 .111 2.101 .037 .728 1.373
resources
Community -7.651 1.783 -.241 -4.291 .000 .650 1.539
pharmacy
Other settinq -4.154 2.835 -.082 -1.465 .144 .651 1.535
Number of years 0.052 ' .057 .049 .911 .363 .712 1. 404
licensed as a
pharmacist
Gender 1.149 1.406 .045 .818 .414 .660 1.514
Manager or .405 1.293 .016 .313 .754 .790 1.267

director/assis
tant /associate/
supervisor
Other position 3. 954 2.339 .084 1. 690 .092 .830 1.205
F = 16.2, H a n d 259 df, p = .000, n = 270
128
pharmaceutical care provision.

The mediational analysis results when adding
pharmacists' demographics as additional control variables

are presented in Tables 44, 45, and 46. There was no
relationship among the five factors of personality and

control variables)

Statistics
Tolerance VIF
Constant -6.538 3.272 -1.998 .047
(intercept)
Extraversion .553 .302 .081 1.834 .068 .780 1.281
Neuroticism 1.176 .386 .144 3.047 .003 .689 1.451
Openness .189 .396 .021 .478 .633 .795 1.258
Agreeableness 1.308 .526 .116 2.488 .013 .704 1.421
Conscientious -0.042 .471 -.004 -.089 .929 .763 1.311
ness
Perceived .768 .049 .735 15.605 .000 .694 1.440
behavioral
control
Workload 0.011 .023 .020 .480 .632 .913 1.095
Adequacy of -0.031 .052 -.028 -.609 .543 .729 1.371
resources
Community -.543 .590 -.045 -.921 .358 .652 1.534
pharmacy
Other settinq -1.174 .937 -.061 -1.253 .211 .655 1.526
Number of -0.011 .019 -.028 -.610 .542 .713 1.402
years licensed
as a
pharmacist
129

Statistics
Tolerance VIF
Gender .396 .465 .041 .851 .396 .662 1.510
Manager or 1.303 .421 .134 3.097 .002 .819 1.221
director/assis
tant/associate/
supervisor
Other position .975 .773 .054 1.261 .208 .835 1.197
F = 28.154, 14 and 255 df, p = .000, n = 269
behavior relative to pharmaceutical care. Therefore, when
adding pharmacists' demographics, behavioral intention did
not mediate between the five factors of personality and
behavior relative to pharmaceutical care.

control variables)

Statistics
Tolerance VIF
Constant -8.962 9.946 -.901 .368
(intercept)
Extraversion 1.336 .916 .075 1.458 .146 .770 1.298
Neuroticism .393 1.185 .018 .332 .740 .665 1.504
130

Statistics
Tolerance VIF
Openness 1.276 1.196 .054 1.067 .287 .794 1.259
Agreeableness -.961 1.605 -.033 -.599 .550 .687 1.455
Conscientious 1.908 1.421 .069 1.342 .181 .7 63 1.311
ness
Intention .921 .189 .352 4 .877 .000 .393 2.546
Perceived .685 .208 .250 3.302 .001 .355 2.815
behavioral
control
Workload 0.066 .063 .046 .970 .333 .913 1.096
Adequacy of .327 .156 .111 2.101 .037 .728 1.373
resources
Community -7.651 1.783 -.241 -4.291 .000 .650 1.539
pharmacy
Other setting -4.154 2.835 -.082 -1.465 .144 .651 1.535
Number of years 0.052 .057 .049 .911 .363 .712 1. 404
licensed as a
pharmacist
Gender 1.149 1.406 .045 .818 .414 .660 1.514
Manager or .405 1.293 .016 .313 .754 .790 1.267
director/assis
tant /associate/
supervisor
Other position 3.954 2.339 .084 1.690 .092 .830 1.205
F = 15.697, 15 and 254 df, p = .000, n = 269
131
Table 4 6 Results of Regression Model 3: Mediational

control variables)
Variable B .
SE P 4
Sig Collinearity
Statistics
Tolerance VIF
Constant -14.986 10.301 -1.455 .147
(intercept)
Extraversion 1.845 .950 .104 1. 942 .053 .780 1.281
Neuroticism 1.476 1.215 .069 1.215 .226 .689 1.451
Openness 1.450 1.248 .062 1.162 .246 .795 1.258
Agreeableness .244 1.655 .008 .147 .883 .704 1.421
Conscientious 1.869 1.484 .068 1.260 .209 .763 1.311
ness
Perceived. 1.437 .150 .525 9. 602 .000 .748 1.337
behavioral
control
Workload 0.076 .071 .053 1.070 .286 .913 1.095
Adequacy of .298 .162 .101 1.836 .068 .729 1.371
resources
community -8.151 1.858 -.256 -4.388 .000 .652 1.534
pharma cry-
other setting -5.236 2.950 -.103 -1.775 .077 .655 1.526
Number of years 0.041 .059 .039 .695 .487 .713 1.402
licensed as a
pharmacist
Gender 1.514 1.4 65 .060 1. 033 .302 .662 1.510
Manager or 1.605 1.325 .063 1.212 .227 .819 1.221
director/assis
tant /associate/
supervisor
Other position 4 .852 2.434 .103 1. 993 .047 .835 1.197
F = 13.878, 14 and 255 df, p = .000, n = 269
132
Summary
Pharmaceutical care provision was the behavior of
interest in this study. Environmental factors always
influence professional behavior like the provision of
pharmaceutical care therefore, practice environmental
factors were added as the control variables in all models.

The only dimension of the Five Factor Model of personality
found to have a significant association with behavior
relative to pharmaceutical care when controlling for the

practice environmental factor was openness. Two control
variables found to be significantly related with
pharmaceutical care provision were adequacy of resources and
types of practice setting.

When adding social cognitions contained in the Theory
of Planned Behavior — perceived behavioral control,
behavioral intention — to predict behavior, none of the
five factors of personality were significantly associated

with behavior relative to pharmaceutical care. All of the
social cognitions that added into the model were
significantly associated with behavior. Adequacy of
resources and types of practice setting were still
significantly related with behavior.
In the post hoc analysis, when pharmaceutical care

provision was regressed on all key variables which are the
five factors of personality - extraversion, neuroticism,
133
openness, agreeableness, and conscientiousness — and the

social cognitions contained in the Theory of Planned
Behavior — attitude toward pharmaceutical care, subjective
norm, perceived behavioral control, and behavioral intention
— and controlled for the practice environments, none of the
five factors of personality were significantly associated

with behavior. There were only two social cognitions that
significantly predicted pharmaceutical care provision, which
were attitude toward pharmaceutical care and perceived
behavioral control; adequacy of resources and practice
setting types remained significant related to pharmaceutical

care provision.
Another dependent variable of interest in this study
was pharmacists' intention to provide pharmaceutical care.

The only personality dimension found to significantly
predict behavioral intention was agreeableness. All of the

social cognitions - attitude toward pharmaceutical care,
subjective norm, and perceived behavioral control —

significantly predicted behavioral intention. No practice
environmental factors - workload, adequacy of resources, and

practice setting types - were significantly related to the
pharmacist's intention to provide pharmaceutical care.
In the mediational analysis, perceived behavioral
control was added as a control variable into each of the
three regression equations. The results found that
134
neuroticism and agreeableness had significant relationship

with behavioral intention but had no significant
relationships with behavior. The only personality dimension
significantly associated with behavior was extraversion.

When hypothesized mediational variable (behavioral
intention) was controlled, the association between

extraversion and behavior was not significant. The
conclusion that behavioral intention acted as a mediator

between extraversion and pharmaceutical care provision
cannot be made because extraversion had no significant
relationship with behavioral intention. Post hoc analysis,
however, displayed that behavioral intention was the
mediator between openness and pharmaceutical care when
controlling only for practice environmental factor and not

controlling for perceived behavioral control.
Figure 12 demonstrates graphically the results of the
integration of personality, social cognitions, and
environmental factors that influence pharmaceutical care

provision.
135
Agreeableness Openness Extraversion
.Attitude (3=. 530** \p=. 083
Subjective Norm ^=.178** Intention Pharmaceutical

care provision
Perceived 3=. 27 (3=.253

Behavioral
Control
Practice Setting
Adequacy of Resources
*p<0.01
**P<0.05
a : significance when not accounted for intention and perceived

behavioral control.
b : significance when accounted for perceived behavioral control

but not intention
Figure 12. Graphical Results of the Current Study
136
CHAPTER V
DISCUSSIONS
This chapter provides an interpretation and a

discussion of the study on the influences of personality,
social cognition, and environmental factors on
pharmaceutical care. Following a brief overview about the
study, the section discusses the contribution of personality
to pharmaceutical care, the psychological theoretical model,

direct determinants of behaviors of interest, intention as a
mediator, scientific implications and practice implication

the limitations of the study are presented and future
research is introduced. The last section of this chapter is

the conclusion.
Overview
This study had three objectives: 1) to investigate
pharmacists'' personality in predicting pharmacists' behavior
relative to pharmaceutical care, controlling for

environmental factors; 2) to test a theoretical model that
integrates personality and social cognitions to predict
behavior; and 3) to examine the mediational effects of
social cognitions that link the basic personality structures
to behavior. A broad personality ■assessment, the five-
137
factor model, was used to frame pharmacists' personality.

The social-cognitive constructs set forth in the Theory of
Planned Behavior were used as a framework for pharmacists'
social cognitions in the current study.
A single, self-administered mail survey was used in the

current study. Six hundred Iowa pharmacists were randomly
selected as a study sample. The usable response rate of the

survey was 60.14%. Ordinary least squares (OLS) in a
multiple regression context was used as the method of
analysis.
The implications of the current study can be summarized
as the following: 1) openness, a dimension of personality,
had a positive relationship with pharmaceutical care

provision and intention to provide pharmaceutical care; 2)
agreeableness had a positive relationship with intention to
provide pharmaceutical care; 3) social cognitions —

attitude, subjective norm, perceived behavioral control —
had strong influences on intention to provide pharmaceutical
care; 4) behavioral intention and perceived behavioral
control had strong influences on pharmaceutical care
provision; 5) perceived behavioral control had both direct

and indirect influences on pharmaceutical care provision; 6)
attitude also had both direct and indirect influences on
pharmaceutical care provision; 7) the effect of personality

of pharmacists on pharmaceutical care provision and
138
pharmacist intention to provide pharmaceutical care was not

as strong as their social cognitions; 8) the influence of
one personality dimension, openness, on pharmaceutical care
provision was mediated by behavioral intention; 9) practice
environmental factors — type of practice setting and
adequacy of resources — also had significant influences on
pharmaceutical care provision; 10) agreeableness, attitude,

subjective norm, and perceived behavioral control served as
predictors for pharmacists' intention to provide
pharmaceutical care; 11) behavioral intention, perceived
behavioral control, adequacy of resources and type of

practice setting served as predictors for behavior relative
to pharmaceutical care; 12) the results supported the Theory
of Planned Behavior; 13) practice environmental factors can

influence pharmaceutical care provision but did not
influence pharmacists' intention to provide pharmaceutical

care; and 14) pharmacists' demographics did not influence
Contribution of Personality
to Pharmaceutical Care Provision
The results partially supported the hypothesis that
personality factors (i.e. extraversion, openness,

agreeableness, conscientious, and neuroticism) explain
variations in pharmaceutical care provision, controlling for
workload, type of practice setting, and adequacy of
139
resources. Only openness explained pharmaceutical care

provision. Though the other four dimensions of personality
did not statistically explain pharmaceutical care provision,
the direction of the relationships between each personality

dimension and behavior was as expected (extraversion,
agreeableness, conscientiousness and openness had positive

relationships and neuroticism had a negative relationship
with behavior relative to pharmaceutical care).
Of these five personality factors, extraversion and
openness had significant positive bivariate correlations
with pharmaceutical care provision and intention to provide
pharmaceutical care. When all five factors of personality

were used in a multivariate analysis that controlled for the
practice environment, openness remained a significant but
weak predictor, and extraversion disappeared statistically.
In the multivariate model to predict pharmacists' intention
to provide pharmaceutical care, agreeableness was a
significant predictor but extraversion and openness were not
significant, even though both of them had significant
bivariate correlations with intention.

Data from the present study illustrated that
pharmaceutical care provision would be predicted by greater

openness of personality. "Open people are characterized by
an active motivation to seek out the unfamiliar experience
and are apt to be particularly reflective and thoughtful
140
about the idea they encounter. They are able to grasp new
ideas and enjoy doing so" (McCrae, Costa, 1997). Openness
usually is characterized by intellect and unconventionality.
People who have a high score on openness, therefore, are
philosophical, flexible, creative, intellectual,
imaginative, autonomous, and nonconforming. The
flexibility, creativity, and intellectual orientation of
individuals who exhibit openness are instrumental to success
in many occupations. Pharmaceutical care is still a new
concept in pharmacy practice, and cognitive services are the

critical elements of pharmaceutical care provision. The
descriptions of open people reflect the characteristics
required by new practice activities in pharmacy.
Prior to the present study, no study used the Big Five
factor of personality in pharmacy or pharmaceutical care.
The literature that supported the relationship of these five
personality factors and pharmaceutical care from the present

findings were research in the area of the Big Five
personality and other work-related behavior. The study of

Barrick and Mount (1991) could provide an explanation to
support the findings of current study. They conclude that
employees who are high on the openness dimension may be more

ready and willing to engage in new learning experiences than
those who are lower in openness.
141
Agreeableness had no significant direct association

with pharmaceutical care provision. However, agreeableness
had a significant bivariate correlation with behavioral
intention and significant association with behavioral
intention when controlling for the other personality
dimensions, attitude, subjective norm, perceived behavioral

control, and practice environmental factors. Theoretically,
intention leads to behavior. Even though agreeableness had
no direct effect on behavior, it could have an indirect
effect on pharmaceutical care provision through intention.
Characteristics of agreeableness include sympathy,
generosity, kindness, helpfulness, and consideration.

Agreeable people are trusting of others, caring, good-
natured, cheerful, and gentle. One conceptual explanation
of the association between agreeableness and pharmacists'

intention to provide pharmaceutical care could be the
relation with prosocial behavior. "Prosocial behavior
typically is defined as voluntary behavior intended to
benefit others. It can be conceptualized as a form of
agreeableness" (Graziano, Eisenberg, 1997). Pharmaceutical
care provision can be considered as prosocial behavior

positively reflecting on "good" pharmacist practices.
Agreeableness has two related notions, which are being

cooperative and likeable. The cooperative nature of
agreeable individuals may lead to more success in
142
occupations where teamwork or customer service is relevant.

Pharmaceutical care provisions are mostly cognitive services
that pharmacists provide to the patients. These services

need pharmacists to be cooperative at least with patients
and other health care providers in order to achieve positive

patient outcomes (Hepler and Strand, 1990). The results
from the present study conceptually make sense with the

above reasons.
Literature that supported the relationship of
agreeableness and pharmaceutical care as found in the
present study were the association of the Big Five
personality with other work-related behavior (Dalton and

Wilson, 2000; Conway, 2000; Tanoff, 1999; Neuman and Kickul,
1998; Mount, Barrick and Stewart, 1998; Hurley, 1998;
Piedmont and Weinstein, 1994).
Barrick and Mount (1993) have explained that
conscientiousness, extraversion, and agreeableness are

stronger predictors of job performance if employees have
greater autonomy and fewer behavioral constraints. The
present study showed that perceived behavioral control and
adequacy of resources were significantly associated with
pharmaceutical care provision. Pharmacists in this sample

may feel greater behavioral constraints. Pharmacists'
perception of behavioral constraints could inhibit them from
143
providing pharmaceutical care, therefore agreeableness was

not related with pharmaceutical care provision.
Extraversion was not a significant predictor.
Bivariate statistics hinted at some possible influence not
demonstrated in the multivariate portion of the study.

"Extraverts are more externally and objectively focused;
they are more concerned with other people and the world
around them, and oriented more toward action than thought"

(Watson, Clark, 1997). Extraversion, typically, tends to
encompass socially oriented characteristics such as being

outgoing and friendly, but also includes traits such as
dominant, aspiring, active, adventurous and assertive.
Extraverts are more likely to take on leadership roles
(Watson and Clark, 1997) and to prefer frequent interaction

with others (Satava, 1997). The characteristics of
extraverts conceptually correspond with new practice

activities that require communications with patients and
other health care providers and seeking out drug-related

problems. Even though extraversion had a bivariate
correlation with pharmaceutical care provision, in the

multivariate analysis, when controlling for the practice
environment, extraversion had no significant association
with pharmaceutical care provision. As said by Barrick and

Mount (1993), extraversion is a stronger predictor of job
144
performance if individuals feel fewer behavioral

constraints.
Contrary to expectation, the other two personality
dimensions, conscientiousness and neuroticism, in the Five

Factor Model were not significantly related in any way with
pharmaceutical care provision and intention to provide

pharmaceutical care. Thus, for the pharmacists in this
study, being habitually careful, reliable, hard working,
well-organized, and purposeful, or anxious, depressed,
impulsive, and emotionally unstable were not related to

Conscientiousness was most consistently related to
performance across jobs (Barrick and Mount, 1991; Tett et

al., 1991; Salgado, 1997). As addressed above,
conscientiousness appears to have three related notions,
which are achievement orientation, dependability, and
orderliness. One who scores high in conscientiousness,

therefore, tends to be hardworking, persistent, responsible,
careful, planful and organized. It is not surprising that

this personality dimension is a valid predictor of success
at work. Recent empirical evidence supports the importance
of conscientiousness at work. Several studies provide
robust support for the usefulness of conscientiousness as a
predictor of job performance and job satisfaction (Barrick,

Mount, 1991; 1993; Barrick, Mount, Strauss, 1993).
145
Both job satisfaction and job performance are the

outcomes of work-related behavior. Pharmaceutical care
provision is not an outcome of behavior, rather it is a
behavior. This issue is a possible reason that there is no
relationship found between conscientiousness and
pharmaceutical care provision in the current study.

Conceptually, conscientiousness should reflect frequency of
doing activities. Most of the activities a pharmacist
performs, however, follows his job description as required

by his employer. Therefore, regardless of the level of
conscientiousness, pharmacists might have to follow their

job descriptions, in which case conscientiousness may be
less important.
Neuroticism influences at least two related
inclinations, which are anxiety and one's well-being.
Highly neurotic people tend to be stress prone, unstable,
personally insecure and depressed. This, therefore, refers

to a lack of positive psychological adjustment and emotional
stability. Thus, neuroticism tends to inhibit rather than
facilitate work performance. There was an inverse relation
between neuroticism and job satisfaction (Tanoff, 1999;
Francis and Robbins, 1999; Sah and Ojha, 1989; Anand, 1977;
Guha, 1965) , customer service (Furnham and Coveney, 1996),
job performance (Piedmont and Weinstein, 1994) and teacher

performance (Cutchin, 1999). Research on the relationship
146
with work-related behavior has been mostly about job stress,

intention to stay, burnout (Walsh, Wilding, Eysenck,
Valentine, 2000; Grundy, 2000), and coping behaviors
(Parkes, 1986), which are outcomes of behavior. It is a
possible explanation that neuroticism may be not important

to pharmaceutical care provision because pharmaceutical care
provision is not the outcome of behavior and pharmacists are

engaged in following their job description.
To conclude, the present study showed that personality,
especially openness, did significantly contribute to the
explanation of behavior relative to pharmaceutical care when
accounting for other personality dimensions and controlling

for environmental factors. Agreeableness did significantly
contribute to the explanation of intention to provide
pharmaceutical care when accounting for other dimensions of
personality, attitude, subjective norm, and perceived

behavioral control, and controlling for environmental
factors. Extraversion had a significant bivariate

correlation with pharmaceutical care provision and intention
to provide pharmaceutical care.
Psychosocial Theoretical Model
To predict factors influencing pharmacists' intention

to provide pharmaceutical care, the hypothesis was tested
that extraversion, openness, agreeableness,
conscientiousness, neuroticism, attitude, subjective norm,
147
and perceived behavioral control would explain variation in

behavioral intention, controlling for workload, adequacy of
resources, and type of practice setting. The results
indicated that agreeableness, attitude, subjective norm, and
perceived behavioral control were significant predictors of
behavior, when controlling for the practice environment.

None of the practice environmental factors were
significantly related with the intention to provide
pharmaceutical care. Attitude was the strongest predictor
of pharmacists' intention to provide pharmaceutical care,

followed by perceived behavioral control and subjective
norms, with agreeableness being the least important.
Results from the present study contradicted the study of

Farris and Kirking (1995). They found that social norm
toward trying was a stronger predictor than attitude.
However, results from the present study were consistent with
the findings from Odedina et al. (1997), in that among the
three constructs of attitude, subjective norm, and perceived
behavioral control, attitude was the most important

predictor with subjective norm being the least. In fact,
Fishbein and Ajzen (1975) reported that the relative weight
of major components in the model varies with the behavior in
question. The results from the present study supported the
Theory of Planned Behavior as proposed. Behavioral intention
was mediated by these three basic determinants including
148
attitude toward performing the behavior, subjective norms,

and perceived behavioral control (Ajzen, Fishbein, 1980).
To predict factors influencing pharmacists' self-
reported behavior relative to pharmaceutical care, the
hypothesis was tested that extraversion, openness,
agreeableness, conscientiousness, neuroticism, behavioral
intention, and perceived behavioral control would explain

variation in pharmaceutical care provision. The results
indicated that intention and to a lesser extent perceived
behavioral control were significant predictors of
pharmaceutical care provision, when controlling for practice
environmental factors. None of the five factors of
personality were found to predict pharmacists' self-reported
behavior relative to pharmaceutical care. Two environmental

factors, which were adequacy of resources and type of
practice, had significant influence on pharmaceutical care
provision. This result was consistent with the Theory of
Planned Behavior.
The finding from the present study that intention was a
stronger predictor for behavior than perceived behavioral

control was in contradiction of Odedina et al. (1997). They
found that perceived behavioral control was stronger than
intention. The current study provided confirmation of the

significance of perceived behavioral control in the
prediction of behavior and supported the Theory of Planned
149
Behavior as proposed. Perceived behavioral control
influenced both behavioral intention and behavior.

In conclusion, the present study demonstrated that
attitude toward pharmaceutical care was the most important
predictor of both intention and behavior. Pharmacists with

more intention to provide were more likely to provide
pharmaceutical care as their feelings about performing

pharmaceutical care activities became more favorable.
Efforts of augmenting pharmaceutical care provision to the
society by changing intention could be possible through
changing the attitudes of pharmacists. Interventions should
focus on determinants of these favorable feelings about

This study also verified the significance of social

normative beliefs in influencing a pharmacist's intention to
provide pharmaceutical care. Theoretically, subjective norm
has an indirect effect on behavior through intention. The
present study also demonstrated intention as a significant
predictor of behavior. Pharmacists who were identified as
having the beliefs that most people who were important to
them think they should perform pharmaceutical care had
stronger intentions to provide pharmaceutical care and were

more likely to be able to transform their intentions to
behavior.
150
Pharmacists' beliefs about the degree of control they

had over providing pharmaceutical care to their patients
were good predictors of both intention and behavior.
Pharmacists who perceived that pharmaceutical care
activities would be less difficult to perform not only had
greater intention to provide pharmaceutical care but also

provided them at higher rates.
The results from the present study showed that social
cognitions are stronger predictors of behavior than
personality. One possible explanation is the
operationalization of concepts. The social cognitive
constructs contained in the Theory of Planned Behavior were
operationalized specific to each behavioral criterion, which
involves action, target, context and time. The personality

measures (BFI) used in the present study were global
measures and not specific to the behavioral criterion.
Direct Determinants of Behavior
Post hoc analyses explored the direct determinants

among all five basic elements of personality, social
cognition constructs, and practice environmental factors on
pharmaceutical care provision. The results indicated that
attitude, perceived behavioral control, adequacy of
resources, and type of practice setting are significant
predictors of pharmaceutical care provision with an overall

variance explained of 4 9%. The best predictor of behavior
151
was attitude. Perceived behavioral control had more

influence than adequacy of resources. Odedina et al. (1997)
found past behavior recency, and perceived behavioral
control, were the direct determinants of pharmaceutical care

provision with an overall variance explained of 57%. It was
not surprising that subjective norm was not a significant
direct predictor of behavior. This result was similar to

the result from Odedina et al (1997). In addition,
theoretically, subjective norm has no direct effect on
behavior; rather, it has indirect effect through behavioral

intention.
Surprisingly, behavioral intention was not a
significant predictor of behavior when accounting for
attitude and subjective norm but attitude had direct

influence on behavior. As reported by Bagozzi and Yi
(1989), some researchers have discovered that attitudes can
influence behavior directly. Zuckerman and Reis (1978)
found a considerable and statistically significant effect of
attitudes on blood donation behavior. Manstead et al (1983)
found that attitudes concerning behavior made an independent

and significant contribution to the prediction of infant-
feeding behavior. This result from the post hoc analysis of
the present study was consistent with some research
addressed above and supported the notion that intentions may

not completely mediate the effects of attitudes on behavior
152
and may even be less important than attitude as a
determinant of behavior. The role of intention may vary

across situations. The formation of attitude toward
pharmaceutical care in this pharmacist sample may be
sufficient to induce behavior relative to pharmaceutical

care.
As expected, perceived behavioral control was a
significant predictor of pharmaceutical care provision and
this result was similar to Farris and Schopflocher (1999)
and Odedina et al. (1997). In situations where individuals
perceive limitations to their ability to perform behaviors,

perceived behavioral control has a major influence on
intention and behavior. Pharmaceutical care provision is
behavior that is not completely under one's volitional
control, thus the results of the present study support

theory.
According to the Theory of Planned Behavior, perceived
behavioral control also reflects the actual control a person

has over the situation. Because it may be difficult to
measure actual control, perceived control is considered to

be its surrogate measure (Ajzen, 1985). Another aspect of
actual control has been examined in research focusing on
situational influences on behavior. The lack of actual
control over factors such as opportunities, resources, and
skills is one of the reasons for not being able to perform
153
according to intention (Ajzen, 1991). Once actual control
is separated from perceived control, it can be examined to

determine its role in performance of actual behavior.
Environmental factors in the present study could be
considered as an actual control. The results of the present
study showed that pharmacists' belief about the degree of
control they had over providing pharmaceutical care to their

patients was a better predictor of behavior than the actual
control, adequacy of resources. This result was confirmed

by Farris and Schopflocher (1999). They said, "The
environment in which pharmacists work may be critical, but
the degree of control that pharmacists may perceive over
hectic work environments may be as key."
The fit of person to practice settings may be due to
the choice processes. Pharmacists tend to choose practice

settings where the situation fits their personality
(Draugalis and Bootman, 1986; Silberman, Cain and Mahan,

1982; Rezler, Mrtek, and Manasse, 1975). Personality
characteristics were not randomly assigned to different
practice settings. The type of practice setting therefore

was significantly related to pharmaceutical care provision
in the present study.

Pharmacists' demographic variables, which were the
number of years licensed as a pharmacist, gender, current
position, and degree earned, were also added into the model
154
with all key variables to predict pharmaceutical care. The

incremental contribution made by all pharmacists''
demographic variables was 4%, but R2 change was not
significant. The result indicated that all pharmacists'
demographic characteristics were not significant to predict

pharmaceutical care provision. This finding was consistent
with the finding of Farris and Kirking (1995). They found
that demographics and practice characteristics produced no

statistically significant differences in pharmacists'
intention to try.
Behavioral Intention as a Mediator
To investigate whether social cognition could mediate
between personality and behavior, the hypothesis was tested

that behavioral intention would serve as a significant
mediator in the association between extraversion, openness,
agreeableness, conscientiousness and neuroticism and
pharmaceutical care provision, controlling for practice
environmental factors. Perceived behavioral control was
found to have a significant relationship with both

behavioral intention and pharmaceutical care provision.
Therefore, it was added as another control variable in the
mediational analysis. Only extraversion and openness showed
possible mediation by intention.
The results indicated that the conditions for
mediational role of behavioral intention between
155
extraversion and pharmaceutical care provision were not met

because there was no significant relationship between
extraversion and behavioral intention. The conditions for
mediation were met but only perceived behavioral control was
not included. This implied that perceived behavioral
control might mediate between openness and behavior.
The specific mediational link between personality,

behavioral intention, and pharmaceutical care provision does
not appear to have been tested in a pharmacist population

prior to the current study. The present results
demonstrated that openness had direct association with
pharmaceutical care provision through intention to provide
pharmaceutical care. This indicates that pharmacists with
high degree of openness are likely to have more intention

and more pharmaceutical care provision.
Many scholars have mentioned that personality could
affect pharmaceutical care provision (Holland, Nimmo, 1999;

Campagna, Newlin, 1997). Before this study, however, there
was no empirical study of personality and pharmaceutical
care provision. Though there is a growing body of

literature about mediational role of social cognitions
between personality and behavior (Barrick, Mount, Strauss,
1993; Day, 1998; Edwards, 1998), the inconsistent use of the

Five Factor Model in those empirical research does not allow
for clearer synthesis of the empirical literature. The
156
consistency of the finding from the present study with other

studies could not be compared since there is no exact
linkage among openness, behavioral intention, and behavior,
especially in the pharmacy area. The present finding
suggests that a mediator exists between personality and
behavior.
To conclude, when accounting for other personality
factors and controlling for environmental factors, openness
was statistically associated with pharmaceutical care
provision, and behavioral intention acted as a mediator
between them. When perceived behavioral control was added
as a control variable, extraversion was statistically
associated with pharmaceutical care provision, but

behavioral intention did not act as a mediator between them.
Scientific Implications
This study supports and extends the development of
theoretical models of pharmaceutical care provision. The

results from the psychological model in the present study
provided support for the usefulness of the Theory of Planned
Behavior and the Five Factor Model in identifying

determinants of self-reported behavior. These two models,
therefore, could be used as conceptual frameworks for
identifying determinants of other professional behaviors.
Personality variables contributed somewhat to the
prediction of behavior in this study. The relationship
157
between openness and behavior and the relationship between
agreeableness and intention were modest but significant.

Thus, both factors should be included in models of
professional behavior. The results fully supported the

Theory of Planned Behavior.
Before this study, there was no empirical study about
the way personality relates to pharmaceutical care
provision. This study quantified what many scholars have
suggested, that personality influences pharmaceutical care
provision. Besides providing empirical evidence, this study

also extended the knowledge to understand how personality
traits may influence behavior by focusing on a proximal
process variable, such as behavioral intention, as the
mediator between personality and behavior. To be specific,
this study contributed to a body of evidence suggesting that
one factor of the Five Factor Model, openness, is an
important basic structure of personality for predicting
professional behavior.
The findings also provided evidence that environmental
factors were important to behavior, and also supported the
idea that environmental factors matter more than personality
in determining how people act. These findings add to the
growing body of literature documenting the roles of
personality, social cognitions and environment as important
contributions to predicting and understanding behaviors.
158
-Practice Implications
The study findings supported the partial contribution
of personality in predicting pharmaceutical care behavior.
The influences of social cognitions on pharmaceutical care
provision were stronger than personality was. Environmental
factors influenced pharmaceutical care provision.

Given the current interest in changing pharmacy
practice through increasing provision of pharmaceutical
care, the information of this study is useful for designing

programs. Specifically, it is important to encourage
pharmacists to provide more pharmaceutical care. The

results of this study could also pertain primarily to the
selection or promotion of employees.
According to the Theory of Planned Behavior, behavioral
changes are the result of changes in beliefs. It implies

that we need to expose pharmacists to information that will
produce changes in their beliefs. Social normative beliefs
in influencing pharmacist's intention to provide
pharmaceutical care should also be focused.
As demonstrated in the current study, pharmacists'
beliefs about the degree of control they had over providing

pharmaceutical care to their patients was also critical to
both pharmacist intention to provide pharmaceutical care and

self-reported pharmaceutical care behavior. Intervention
159
should be established for improving the degree of control

over pharmaceutical care provision.
Two factors, openness and agreeableness, were
significantly associated with pharmaceutical care provision
and intention to provide pharmaceutical care. These results

can guide in the selection of pharmacists who are inclined
to be curious, imaginative, creative, original,
psychologically minded, flexible, good-natured, acquiescent,
courteous, helpful, and trusting, to match with the demand
of pharmaceutical care activities. The matching between
personality and the job's activities can bring motivation
and satisfaction to stay in those job's activities and

increase productivity.
The results of the current study also emphasized the
importance of the practice environmental factors; although
they were weaker predictors than social cognitions they were
stronger predictors than personality for explaining
pharmaceutical care provision. This study suggests creating

an environment conducive to pharmaceutical care provision
with a private area for patient counseling, a computer
system, and trained pharmacy personnel, which can facilitate
pharmacists to provide pharmaceutical care.
Limitations
The first set of limitations in the present study was
considered as conceptual. The Big Five dimensions of
160
personality were used as a framework in the present study.

Thus the domain of personality was reduced to five factors,
and the model may not provide adequate specificity. Broad
traits may not be as helpful as narrow traits at predicting
In addition, we cannot randomly assign a personality
characteristic to a person and then follow them over time.

This did not allow us to establish the direction of
causality between personality traits and pharmaceutical care
provision. The causal effect cannot be established with

this type of research design.
Ajzen and Fishbein (1980) suggested defining the
behavior of interest in terms of action, target, context,
and time, and then defining the attitude, subjective norm,
perceived behavioral control, and behavioral intention using
specific phrases and adjectives and corresponding to the

behavior of interest. Behaviors in the present study were
defined in terms of eleven actions. Since the lengthy
questionnaire from the pilot test led to a low response
rate, these eleven activities were grouped into three
dimensions and items for measuring attitude, subjective
norm, perceived behavioral control, and behavioral intention

were corresponded to each domain rather than each activity.
There was a lack of the correspondence among behaviors and

these social cognition constructs in the present study.
161
Intention and behavior were collected at the same time.

Analysis of causal determinants within the context of the
Theory of Planned Behavior was not possible. The behavior
relative to pharmaceutical care in the present study was a
self-reported behavior, not observational behavior, and

social desirability of a positive response may exist.
The second set of limitations in the present study was
methodological. A few methodological issues provide
qualifications to the findings. Non-response analyses were
not conducted. Non-respondents may have been different in
terms of the study key variables and non-response bias could

occur. This bias could affect the generalization of study
results to the population. In addition, the positions of
the items representing each measure were close together in
the questionnaire. A few cases of response set, where the
same numbers were circled for all questions, did exist and
resulted in high correlation among these social cognition
constructs. A large sample size may be required to achieve

the statistical power needed for the results to reach
statistical significance. There were 62 missing data points
from items measuring workload. This brought the numbers of

sample (N) in the multivariate analyses down from 341 to 271
and resulted in lower statistical power. Inevitably,

multiple variables can have multivariate relationships in
the model. This made the results more difficult to
162
interpret than bivariate relationship. An effort was made
to control for the effects of confounding factors — type of

practice setting, workload, and adequacy of resources. By
controlling for the effects of every associate of the

variable of interest, it is possible to remove enough shared
variance to eliminate the effect of variable of interest
even if it is important.
The present study was conducted only in the state of

Iowa. The sample frame included all pharmacists registered
in Iowa as recorded in a listing by the Iowa Pharmacy
Association in September 1999. The generalizability of
results from the study to a metropolitan area might be

questionable.
Future Research
The current study only examined the five factors of
personality. More specific measures of the Five Factor

Model that separate the five major factors into more
specific sub-dimensions such as NEO-FFI (Costa and McCrae,
198 5) should be explored in the area of pharmacy. Specific
facets of personality may be better predictors of
pharmaceutical care provision. An investigation of narrowly
defined or situationally rooted personality constructs such
as work-oriented locus of control, or situation-specific
constructs of self-efficacy, endurance, and self-esteem
would be also a possible future research idea.
163
Post hoc analysis indicated attitude and perceived

behavioral control were significant predictors of
pharmaceutical care provision. The mediational roles of
attitude and perceived behavioral control between
personality and behavior should be further investigated. All

analyses also pointed to the significant role of
environmental factors. The practice environmental factors
may function as possible moderators. The use of
interactional designs may discover an important role for the
personality constructs where this study has yielded none.
Continued study of the roles of the mediating and moderating
variables of social cognition and environmental factors in
personality-professional behavior would be interesting.

Because of the cross-sectional nature of this study,
analysis of causal determinants within the context of the

Theory of Planned Behavior was not possible. It is
recommended that to fully test the theory, a longitudinal
study of pharmacists' intentions and actual behavior

relative to pharmaceutical care be conducted.
The present study demonstrated simple mediation, on
which the analysis focused using a pair of path diagrams.
Ordinary least squares (OLS) in a multiple regression

context was used to estimate these effects. More complex
path diagrams or another statistical technique such as
164
structural equation modeling would also be a possible future

investigation.
Results from the present study indicated that practice

environment did affect pharmaceutical care provision. The
current study considered only 3 practice environmental
factors. Future research needs to explore the role of other

environmental factors that can influence pharmaceutical care
provision. Interaction effects of environmental factors
with behavioral intention on pharmaceutical care provision
should be further observed.
Pharmaceutical care activities in the present study
were grouped into three dimensions, which were patient

assessment, drug-related problem resolution, and
documentation. Personality, social cognitions and practice
environments may affect each dimension differently. Further
analysis on each dimension should be examined.
Pharmacists tend to choose the practice settings where
the expectations demanded of the professional role fit their
personality. It would also be likely that the environments

of practice might bring persons of a similar type together.
The relationships between the five factors of personality
and practice settings are interesting for further
investigation.
The typology analysis using the BFI would be
interesting. The insight into types of people based on the
165
Big Five profile should be explored. Types of people being

attracted to do the different dimensions of pharmaceutical
care activities are also possible subjects for
investigation. Whether the practice settings in pharmacy
attract persons with different definable Big Five
personality profiles would also be interesting to examine.
Conclusion
This study provided insight into the interface between
personality psychology and social psychology in approaching

the same target behavior. The results show that pharmacists
who are inclined to be curious, creative, psychologically
minded, and flexible are more likely to provide

pharmaceutical care to their patients. Pharmacists who are
being cooperative and likeable have more intention to
provide pharmaceutical care. Besides these two personality
factors, pharmacists who have more intention to provide

pharmaceutical care were more likely to provide it, as their
attitudes about performing pharmaceutical care activities
were favorable. Social normative beliefs about

pharmaceutical care activities influenced pharmacists'
intention to provide pharmaceutical care. Pharmacists who
believed that they had control over providing pharmaceutical
care had more intention and were more likely to provide

pharmaceutical care. More pharmaceutical care activities
were provided, given adequacy of resources for facilitating
166
those activities. Pharmacists' demographic characteristics

were not found to have significant influence on
167
APPENDIX A
DESCRIPTIVE DATA OF ITEMS
168
Table 47. Descriptive Statistics for Individual Items

of the Personality Measure (BFI) (Scale 1-5:
Strongly Disagree-Strongly Agree)
Items N Means S.D. Min Max

I see m y s e l f as someone
w h o .....
l.is talkative. 341 3.61 .99 1.00 5.00

2 .tends to find fault with 341 2.54 .94 1.00 5.00
others.
3.does a thorouqh job. 341 4.44 .58 2.00 5.00
4.is depressed, blue. 341 1.86 .93 1.00 5.00
5.is original, comes up with new 341 3.59 .80 2.00 5.00
ideas.
6 .is reserved. 341 2.90 1.07 1.00 5.00
7.is helpful and unselfish. 341 4.13 .59 2.00 5.00
8 .can be somewhat careless. 341 1.93 .86 1.00 5.00
9.is relaxed, handles stress 341 3.47 .90 1.00 5.00
well.
1 0 .is curious about many 341 3.98 .81 1.00 5.00
different things.
1 1 .is full of energy. 341 3.67 .81 1.00 5.00
1 2 .starts quarrels with others. 341 1.45 .60 1.00 4 .00
13.is a reliable worker. 341 4.76 .48 1.00 5.00
14.can be tense. 341 3.17 1.01 1.00 5.00
15.is ingenious, a deep thinker. 340 3.33 .84 1.00 5.00
16.generates a lot of 341 3.46 .77 1.00 5.00
enthusiasm.
17.has a forqiving nature. 341 3.86 .78 1.00 5.00
18.tends to be disorganized. 341 2.11 1.00 1.00 5.00
19.worries a lot. 341 2.84 1.04 1.00 5.00
20 .has an active imagination. 341 3.54 .88 1.00 5.00
2 1 .tends to be quiet. 341 2.81 1.09 1.00 5.00
169

2 2 .is generally trustinq. 341 4.13 .75 1.00 5.00
23.tends to be lazy. 341 1.58 .73 1.00 5.00
24.is emotionally stable, not 340 3.75 . 86 1.00 5.00
easily upset.
2 5.is inventive. 340 3.43 .79 1.00 5.00
26.has an assertive personality. 340 3.40 .91 1.00 5.00
27.can be cold and aloof. 340 2.21 .97 1.00 5.00
28.perseveres until the task is 340 4.18 .65 1.00 5.00
finished.
29.can be moody. 340 2.68 .95 1.00 5.00
30.values artistic, aesthetic 339 3.62 .87 1.00 5.00
experiences.
31.is sometimes shy, inhibited. 340 2.87 1.05 1.00 5.00
32.is considerate and kind to 340 4 .22 .62 2.00 5.00
almost everyone.
33.does things efficiently. 340 4.13 .66 2.00 5.00
34.remains calm in tense 340 3.75 .71 2.00 5.00
situations.
35.prefers work that is routine. 340 2.84 1.01 1.00 5.00
36.is outgoing, sociable. 340 3.61 .93 1.00 5.00
37.is sometimes rude to others. 340 1.97 .92 1.00 5.00
38.makes plans and follows 340 4.01 .67 1.00 5.00
through with them.
39.gets nervous easily. 340 2.45 .92 1.00 5.00
40.likes to reflect, play with 340 3.58 .79 1.00 5.00
ideas.
41.has few artistic interests. 340 2.58 .98 1.00 5.00
42.likes to cooperate with 340 4.14 .58 1.00 5.00
others.
43.is easily distracted. 340 2.35 .92 1.00 5.00
44.is sophisticated in art, 340 2. 94 1.02 1.00 5.00
music, or literature.
170

of the Attitude toward Pharmaceutical Care
Measure (Item Scale 1-7: Extremely Unfavorable-
Extremely Favorable)

1. My opinion about performing all 298 4.79 1.72 1.00 7.00
of the above patient assessment
activities for one of my patients
in the next 2 weeks is:
2. My opinion about performing all 309 5.13 1.61 1.00 7.00
of the above drug-related
resolution activities for one of
my patients in the next 2 weeks
is:
3. 3.My opinion about performing all 306 4. 63 1.88 1.00 7.00
of the above documentation
activities for one of my patients
in the next 2 weeks i s :

of the Subjective Norm Measure (Item Scale 1-7:
Extremely Disagree- Extremely Agree)

1. Most people who are important 296 4.61 1.73 1.00 7.00
to me think I should perform
all of the above patient
assessment activities for one
of my patients in the next 2
weeks.
2. Most people who are important 304 5.11 1.59 1.00 7 .00
all of the above druq-related
resolution activities for one
of my patients in the next 2
weeks.
3. Most people who are important 302 4 .86 1.73 1.00 7.00
all of the above documentation
activities for one of my
patients in the next 2 weeks.
171

of the Perceived Behavioral Control Measure
(Item Scale 1-7: Extremely Difficult-Extremely
Easy)

1. For me, performing all of the 298 4 .32 1.84 1.00 7.00
above patient assessment
patients in the next 2 weeks is
above drug-related resolution
patients in the next 2 weeks
is:
above documentation activities
for one of my patients in the
next 2 weeks i s :

of the Behavioral Intention Measure (Item
Scale 1-7: Extremely (Jnlikely-Extremely Likely)

1. I intend to perform all of the 298 4.71 1.94 1.00 7.00
above patient assessment
2. I intend to perform all of the 307 4. 96 1.78 1.00 7.00
above drug-related resolution
3. I intend to perform all of the 306 4.31 2.06 1.00 7.00
above documentation activities
for one of my patients in the
next 2 weeks.
172
Table 52. Descriptive Statistics for Individual Items of

the Pharmaceutical Care Provision Measure (Scale
0-5)

1. Asking the patient questions to 294 2.14 1. 63 0 5.00
assess actual patterns of use of
the medication.
2. Asking the patient questions to 294 2.34 1.62 0 5.00
find out if he or she might be
experiencing drug-related
problems.
3. Asking the patient questions to 294 2.42 1.59 0 5.00
find out about the perceived
effectiveness of drugs he or she
was taking.
4. Asking the patient questions to 295 2.32 1 .66 0 5.00
ascertain whether the therapeutic
objective(s) was(were) being
reached.
5. Monitoring drug therapy to 309 3.54 1.69 0 5.00
identify drug-related problems.
6 . Implementing a strategy to 310 3.39 1.67 0 5.00
resolve (or prevent) the drug-
related problems.
7. Following-up the plan established 307 2.51 1.82 0 5.00
for resolving the patient's drug-
related problems.
8 . Documenting information about the 303 2.15 2.08 0 5.00
patient's medical conditions on
written records or computerized
notes or by other formal
mechanisms in a form that could
be read and interpreted by
another health care practitioner
in your absence.
9. Documenting all medications 302 2.79 2.21 0 5.00
currently being taken by the
patient on the written records or
computerized notes or by other
formal mechanisms in a form that
could be read and interpreted by
another health care practitioner
in your absence.
173

1 0 .Documentingthe drug-related 306 2.56 2.12 0 5.00
problems, potential or actual, on
written notes.
1 1 .Documentingany intervention made 305 2.72 2.05 0 5.00
on the patient's profile,
prescription, report, or medical
order in a form that could be
read and interpreted by another
health care professional.
Table 53. Descriptive Statistics for Individual Items of

the Adequacy of Resources Measure3 and Adequacy
of Resources Variable13

1. An area in the pharmacy where 305 3. 67a 1.73a
you can counsel or talk with
patients in private or semi
private manner (your
conversations cannot be easily
overheard by other
individuals).
2. A computer system which helps 318 4 .4 4a 1.35a
you store patient data and
screen for drug-related
problems.
fl)
r-
«—
3. A computer system which helps 315 2 .62a

i
you develop patient care plans

and evaluate outcomes.
4. Trained pharmacy personnel that 314 3 .8 6 a 1.54a
can perform some of your tasks
so that you can spend more time
on pharmaceutical care
activities
a: item scale 1-6 : very poor- excellent

b: scale 4-24
174
APPENDIX B
ITEMS CORRELATION OF EACH MEASURE

AND FACTOR ANALYSIS OF BFI
175
Table 54. Inter-item Correlations for Extraversion

Measure and Extraversion Variable
1 2 3 4 5
1 .Talkative 1
2 .Reserved(r) .51** 1
3.Full of energy .31** .35** 1
4.Enthusiasm .37** .34** .51** 1
5 .Quiet(r) .74** .6 8 ** .38** .40** 1
6 .Assertive .37** .39** .32** .45** .44**

7.Shy(r) .46** .58** .37** .35** .59**
8 .Sociable .63** .49** .40** .40** .60**
9.Extraversion .77** .77** .59** .63** .85**
6 7 8 9
1 .Talkative
2 .Reserved(r)
3.Full of energy
4.Enthusiasm
5 .Quiet(r)
6 .Assertive 1
7.Shy(r) .45** 1
8 .Sociable .46** .77** 1
9.Extraversion .6 6 ** .78** .78** 1

** Correlation is significant at the 0.01 level
(2 -tailed).
176
Table 55. Inter-item Correlations for Agreeableness

Measure and Agreeableness Variable
1 2 3 4 5
l.Find fault(r) 1
2 .Helpful & unselfish .28** 1
3 .Quarrels(r) .33** .27** 1
4.Forqivinq .32** .25** .25** 1
5.Trusting .23** .15** .15** .31** 1
6 .Cold(r) .29** .25** .31** .27** .18**

7.Considerate .24** .43** .34** .42** .26**
8 .Rude(r) .29** .34** .41** .32** .15**
9.Cooperative .07** .26** .23** .18** .14**
10.Agreeableness .61** .57** .59** .62** .48**
6 7 8 9 10
l.Find fault(r)
2 .Helpful & unselfish
3.Quarrels(r)
4.Forgiving
5.Trusting
6 .Cold(r) 1
7.Considerate .31** 1
8 .Rude(r ) .40** .36** 1
9.Cooperative .25** .27** .19** 1
1 0 .Agreeableness .65** .65** .6 8 ** .4 4 ** 1

** Correlation is significant at the 0.01 level (2-tailed).
177
Table 56. Inter-item Correlations for Conscientiousness

Measure and Conscientiousness Variable
1 2 3 4 5
1. Thorough job 1
2 .Careless(r) .41** 1
3. Reliable .41** .17** 1
4.Disorganized(r) .37** .41** .15** 1
5 .Lazy(r) .36** .24** .27** .39** 1
6 .Persevere .42** .29** .23** .29** .26**

7 .Efficient .41** .32** .27** .48** .37**
8 .Make plans .29** .35** .15** .37** .32**
9.Easily distracted(r) .26** .32** .05** .42** .24**
1 0 .Conscientiousness .67** .65** .41** .74** .61**
6 7 8 9 10
1 .Thorough job
2 .Careless(r)
3.Reliable
4.Disorganized(r)
5.Lazy(r)
6 .Persevere 1
7.Efficient .34** 1
8 .Make plans .37** .37** 1
9.Easily distracted(r) .17** .38** .34** 1
1 0 .Conscientiousness .57** .69** .63** .62** 1

178
Table 57. Inter-item Correlations for Neuroticism

Measure and Neuroticism Variable
1 2 3 4 5
1 .Depressed 1
2 .Relaxed(r) .25** 1
3.Tense .30** .45** 1
4 .Worries .37** .31** .40** 1
5.Emotionally .35** .42** .34** .33** 1

stable(r)
6 .Moody .44** .29** .41** .29** .33**
7.Clam (r) .15** .52** .29** .15** .42**
8 .Nervous eas ily .23** .39** .31** .47** .29**
9.Neuroticism .61** .69** .69** .67** .6 6 **
6 7 8 9
1 .Depressed
2. Relaxed(r)
3.Tense
4 .Worries
5.Emotionally
stable(r)
6 .Moody 1
7 .Clam(r) .23** 1
8 .Nervous easily .27** .33** 1
9.Neuroticism .64** .56* .64** 1

** Correlation is significant at the 0.01 level
(2 -tailed).
179
Table 58. Inter-item Correlations for Openness Measure

and Openness Variable
1 2 3 4 5
1 .Original 1
2 .Curious .28** 1
3.Ingenious .45** .31** 1
4.Imagination .44** .39** .39** 1
5.Inventive .62** .34** .52** .51** 1
6 .Aesthetic experiences .17** .28** .1 1 * .19** .18**

7.Prefers routine work(r) .33** .18** .17** .2 1 ** .23**
8 .Play with ideas .44** .33** .43** .51** .45**
9.Artistic interest(r) .19** .27** .13* .23** .23**
1 0 .Sophisticated in art .1 2 * .18** .19** .23** .2 2 **
1 1 .Openness .6 6 ** .58** .60** .67** .69**
6 7 8 9 10 11
1 .Original
2 .Curious
3.Ingenious
4.Imagination
5.Inventive
6 .Aesthetic 1
experiences
7.Prefers routine .04 1
work(r)
8 .Play with ideas .24** .24** 1
9 .Artistic .52** .17** .23** 1

interest(r)
10.Sophisticated in .49** -.02 .23** .46** 1
art
11.Openness .55** .44** .6 6 ** .60** .54** 1
** Correlation is significant at rhe 0.01 level (2-tailed).
* Correlation is significant at the 0.05 level (2-tailed).
180
Table 59. Inter-item Correlations for the Attitude

toward Pharmaceutical Care Measure and
Attitude Variable
1 2 3 4
1 .Attitude: patient assessment 1
activities
2 .Attitude: drug-related .57** 1
resolution activities
3. Attitude: documentation .41** .54** 1
activities
4 .ATTITUDE .80** .77** .78** 1
Table 60. Inter-item Correlations for the Subjective

Norm Measure and Subjective Norm Variable
1 2 3 4
1 .Subjective norm: patient 1
assessment activities
2 .Subjective norm: drug-related .63** 1
3.Subjective norm: documentation .48** .61** 1
activities
4.SUBJECTIVE NORM .82** .79** .78** 1
181
Table 61. Inter-item Correlations for the Perceived

Behavioral Control Measure and Perceived
Behavioral Control Variable
1 2 3 4
1 .Perceived behavioral control: 1
patient assessment
2 .Perceived behavioral control: .57** 1
drug-related resolution
activities
3.Perceived behavioral control: .40** .55** 1
documentation activities
4.PBC .79** .81** .78** 1
** Correlation is significant at the 0 . 0 1 level 2 -tailed).
Table 62. Inter-item Correlations for the Behavioral

Intention Measure and Behavioral Intention
Variable
1 2 3 4
1 .Intention: patient assessment 1
activities
2 .Intention: drug-related .50** 1
3.Intention: documentation .43** .55** 1
activities
4.INTENTION .81** .79 .78 1
182
Table 63. Inter-item Correlations for the Pharmaceutical

Care Provision Measure and Pharmaceutical Care
Provision Variable
1 2 3 4 5 6
1 .Assess actual 1
patterns of
medication use
2 .Find out drug-related .67** 1
problems
3.Find out about .65** .65** 1
effectiveness of
takinq druq
4.Ascertain therapeutic .58** .65** .80** 1
objective
5.Identify drug-related .18** .19** .2 2 ** .2 0 ** 1
problems
6 .Implementing a .17** .19** .15** .2 0 ** .67** 1
strategy for drug-
related problems
7.Following-up .28** .29** .24** .27** .58** .69**
resolving plan for
drug-related
problems
8 .Documenting patient's .28** .27** .16** .23** .18** .2 1 **
medical condition
9.Documenting all .23** .17** .16** .23** .19** .23**
currently
medications
1 0 .Documenting drug- .28** .30** .18** .2 0 ** .31** .35**
related problems
1 1 .Documenting any .28** .33** .19** .2 0 ** .35** .38**
intervention
12.PHARMACEUTICAL CARE .62** .65** .59** .60** .53** .56**
PROVISION
183
7 8 9 10 11 12
1. Assess actual
patterns of
medication use
2 .Find out drug-related
problems
3.Find out about
effectiveness of
taking drug
4.Ascertain therapeutic
objective
5.Identify drug-related
problems
6 .Implementing a
strategy for drug-
related problems
7.Following-up 1
resolving plan for
drug-related
problems
8 .Documenting patient's .30** 1
medical condition
9.Documenting all .32** .58** 1
currently
medications
1 0 .Documenting drug- .44** .51** .36** 1
related problems
1 1 .Documenting any .45** .56** .43** .83** 1
intervention
12.PHARMACEUTICAL CARE .63** .64** .58** .6 8 ** .73** 1
PROVISION
Correlation is significant at the 0.01 level (2-tailed).
184
Table 64. Inter-item Correlations for the Adequacy of

Resources Measure and Adequacy of Resources
Variable
1 2 3 4 5
1 .Private area 1
2. Computer system: .29** 1

store data, screen
for drug-related
problems
3.Computer system: .26** .54** 1
develop patient care
plans and evaluate
outcomes
4.Trained pharmacy .29** .37** .34** 1
personnel
5 .Adequacy of Resources .67** .72** .69** .68** 1
185
Table 65. Structure Matrix from Factor Analysis

Result of BFI
Component
1 2 3 4 5
1 .Talkative .779 .131 .005 -.023 .166
2 .Find fault(r) .054 .007 .007 -.579 .463
3.Thorough -job .008 .202 .695 .021 .202
4.Depressed -.302 -.130 -.192 .529 -.299

5 .Original .301 .687 .275 -.198 -.019
6 .Reserved(r) .785 .174 .078 -.122 .026
7.Helpful & unselfish .077 .256 .200 -.127 .595
8 .Careless(r) .034 .016 .590 -.219 .320
9.Relaxed(r) -.097 -.221 -.151 .665 -.159
10.Curious .180 .592 .101 .038 .185
1 1 .Full of energy .534 .510 .241 -.242 .278
1 2 .Quarrels(r) .032 .038 .234 -.248 .592
13.Reliable .014 .137 .428 -.010 .297
14.Tense -.188 -.005 -.121 .688 -.228
15.Ingenious .087 .64 9 .349 -.082 .076
16.Enthusiasm .589 .447 .235 -.308 .293
17.Forgiving .104 . 110 .039 -.254 .630
18.Disorganized(r) .089 -.047 .695 -.166 .028
19.Worries -.152 .037 -.103 .704 .07 6
2 0 .Imagination .156 .703 .092 -.043 .032
2 1 .Quiet(r) .877 .120 .117 -.130 .086
2 2 .Trusting .011 -.065 .093 -.220 .411
23.Lazy(r) .243 .145 .612 -.220 .256
24.Emotionally stable(r) -.077 -.187 -.156 .634 -.276
25.Inventive .265 .725 .219 -.256 -.027
26.Assertive .613 .361 .232 -.196 -.110
27.Cold(r) .355 -.015 .191 -.224 .582

28.Perseveres .059 .218 .582 -.128 .186
186
Component
1 2 3 4 5
29.Moody -.194 -.094 -.145 .616 -.418
30.Aesthetic experiences .147 .478 -.039 -.076 .210
31.Shy(r) .770 .165 .245 -.381 .111
32.Considerate .153 .168 .189 -.108 .694
33.Efficient .173 .180 .708 -.125 .136
34.Clam(r) -.101 -.412 -.288 .528 -.251
35.Prefers routine work(r) .229 .363 .098 -.205 -.083
36.Sociable .771 .208 .087 -.253 .245
37.Rude(r) .125 .080 .278 -.261 .642
38.Makes plans .232 .293 .633 -.226 .259
39.Nervous easily -.315 -.193 -.319 .644 -.050
40.Play with ideas .073 .697 .110 -.058 .096
41.Artistic interest(r) .118 .498 .045 -.091 .101
42.Coorperative .177 .248 .266 .018 .494
43.Easily distracted(r) .032 -.006 .569 -.275 -.028
44 .Sophisticated in art .052 .4 62 .021 -.041 .088
Extraction Method: Principal Component Analysis.
Rotation Method: Promax with Kaiser Normalization^
187
APPENDIX C
QUESTIONNAIRE, LETTERS, CODE BOOK
188
INFLUEN CES ON P H A R M A C E U T IC A L CARE
Thank you fo r participating in this study. Your responses can help us to understand patient-oriented care. You m ay w rite
comments in the margin i f needed.
1. Please check one item that best describes your employment setting.
O C om m unity Pharm acy (indcp./sm all chain) (# prescriptio ns/da y:___________)
Q C om m unity Pharm acy (cha in , >10 units) (# pre scriptio ns/da y:___________)
O C lin ic Pharm acy (# prescriptio ns/da y:___________)
O H ospital Pharm acy (# beds:___________________ )
O N ursing Hom e/Long T e rm Care (# pa tients/day:_______________)
O O th e r (de scribe ):________________________ (# patients/day o r U prescriptions/day :______________ )
2. I f you have ownership (equity) in your pharmacy, please note the extent o f your ownership:___________ %
3. W hich o f the follow ing best describes your current position?

O M anager o r D ire c to r O Assistant/Associate M anager o r D ire c to r
O S upervisor O S tall/E m ployee Pharm acist
0 R esident/Fellow /Post-graduate trainee O O ther (specify)__________________________ .
I. Please indicate how you see yourself. W e realize that some questions are hard to answer; however, please do the best you can to
make an accurate rating (Place one o f the S numbers that applies to you on the line next to each statement).
For example, I f you strongly agree that you are talkative, place num ber S on the line next to the statement.
1. 5 is talkative
1 - Strongly Disagree 2 - Disagree 3 - Neutral 4 - Agree 5 - Strongly Agree
I see m y s e lf as som eone w h o ____
1. is talkative. 23. tends to be lazy.

2. tends to fin d fault w ith others. 24. ____ is em otionally stable, not easily upset
3. does a thorough jo b. 25. ____ is inventive.
4. is depressed, blue. 26. ____ has an assertive personality.
5. is original, comes up w ith new ideas. 27. ____ can be cold and aloof.
6. is reserved. 28 . ____ perseveres u n til the task is finished.
7. is helpful and unselfish. 29. can be moody.
8. can be somewhat careless. 30 . ____ values artistic, aesthetic experiences.
9. is relaxed, handles stress w ell. 31 . ____ is sometimes shy, inhibited.
10. ____ is curious about many d iffe re nt things. 32. ____ is considerate and kind to almost everyone.
11. ____ is fu ll o f energy. 33. ____ does things efficiently.
12. ____ starts quarrels w ith others. 34. rem ains calm in tense situations.
13. ____ is a reliable worker. 35. ____ prefers work that is rourine.
14. ____ can be tense. 36 . ____ is outgoing, sociable.
15. ____ is ingenious, a deep thinker. 37 . ____ is sometimes rude to others.
16. ____ generates a lo t o f enthusiasm. 38. ____ makes plans and follows through w ith them.
17. ____ has a forgiving nature. 39 . ____ gets nervous easily.
18. ____ tends to be disorganized. 40 . ____ likes to reflect, play w ith ideas.
19. worries a lot. 4 1. ____ has few artistic interests.
20 . ____ has an active im agination. 42 . ____ likes to cooperate w ith others.
21. ____ tends to be quiet. 43 . ____ is easily distracted.
22 . _____is generally trusting. 44 . ____ is sophisticated in art, music, o r literature.
189
II. P atie nt Assessment A ctivitie s:
T h in k about the last five patients o f yours who presented a re fill prescription used to treat a chronic condition such as
asthma, diabetes, o r hypertension. Please indicate how many o f these five patients you provided the follow ing activities.
(Scale: 0-5, please put the number in the blank in fro n t o f the question).
1. Asking the patient questions to assess actual patterns o f use o f the m edication.
2._________ Asking the patient questions to fin d out i f he o r she m ight be experiencing drug-related problems.
3 ._________ Asking the patient questions to fin d out about the perceived effectiveness o f drugs he o r she was
taking.
4 ._________ Asking the patient questions to ascertain whether the therapeutic objective(s) was(were) being
reached.
Questions 5-8 refer to patients who presented a re fill prescription used to treat a chronic condition such as
asthma, diabetes, o r hypertension. Patient assessment activities mean four activities from questions 1-4
above.
5. M y opinion about performing a ll o f the above patient assessment activities fo r one o f m y patients in the
next 2 weeks is: (circle the number that apply to you)
Extremely Unfavorable 1 2 3 4 5 6 7 Extrem ely Favorable
6. M ost people who are important to me th in k I should perform a ll o f the above patient assessment
activities fo r one o f my patients in the next 2 weeks.
Extrem ely Disagree 1 2 3 4 5 6 7 Extrem ely Agree
7. For me, perform ing all o f the above patient assessment activities fo r one o f m y patients in the next 2
weeks is:
Extremely D iffic u lt 1 2 3 4 5 6 7 Extrem ely Easy
8. I intend to perform all o f the above patient assessment activities fo r one o f m y patients in the next 2
weeks.
Extremely U nlikely 1 2 3 4 5 6 7 Extrem ely Likely
III. D rug-related Problem Resolution A c tiv itie s :
Now, th in k about the last five patients o f yours who you discovered were experiencing drug-related
problems. Please indicate how many o f these five patients you provided the follow ing activities.
9. _____ M onitoring drug therapy to identify drug-related problems.

10._____ Im plementing a strategy to resolve (or prevent) the drug-related problems.
11.________ Following-up the plan established fo r resolving the patient’s drug-related problems.
Questions 12-15 refer to patients who you discovered were experiencing chug-related problems. Drug-
related problem activities mean three activities from questions 9-11 above.
12. M y opinion about performing all o f the above drug-related resolution activities fo r one o f my patients in
the next 2 weeks is:
190
13. M ost people who are im portant to me th in k I should perform all o f the above.
drug-related resolution activities fo r one o f m y patients in the next 2 weeks.
Extrem ely Disagree 1 2 3 4 5 6 7 Extremely Agree
14. For me, perform ing a ll o f the above drug-related resolution activities fo r one o f
m y patients in the next 2 weeks is:
Extrem ely D iffic u lt 1 2 3 4 5 6 7 Extrem ely Easy
15. I intend to perform a ll o f the above drug-related resolution activities fo r one o f my

Extrem ely U n like ly 1 2 3 4 5 6 7 Extremely L ik e ly
IV . D o c u m e n ta tio n A c t iv itie s :
Next, th in k about the last five patients o f yours who presented a prescription fo r new
medications used to treat a chronic condition such as asthma, diabetes, or
hypertension. Please indicate how many o f these fiv e patients you provided the
follow ing activities.
16. ______Docum enting inform ation about the patient’s medical conditions on w ritten records o r computerized
notes o r by other formal mechanisms in a form that could be read and interpreted b y another health
care practitioner in your absence.
17.______ Docum enting a ll medications currently being taken by the patient on the w ritten records o r
com puterized notes or by other form al mechanisms in a form that could be read and interpreted by
another health care practitioner in you r absence.
Now, th in k about the last five patients o f yours who you discovered were experiencing drug-related
problems. Please indicate how many o f these fiv e patients you provided the follow ing activities.
18.______ Docum enting the drug-related problem s, potential o r actual, on w ritten notes.
19.______ Docum enting any intervention made on the patient's profile, prescription, report, o r m edical order in
a form tha t could be read and interpreted by another health care professional.
Questions 20-23 refer to patients who presented a prescription fo r new medications used to treat a chronic
condition such as asthma, diabetes, o r hypertension o r who you discovered were experiencing drug-related
problems. Docum entation activities mean the fo u r a ctivities from questions 16-19 above.
20. M y opinion about perform ing a ll o f the above documentation activities fo r one o f m y patients in the next
2 weeks is:
Extrem ely Unfavorable 1 2 3 4 5 6 7 Extrem ely Favorable
21. M ost people w ho are important to me th in k I should perform all o f the above documentation activities
fo r one o f m y patients in the next 2 weeks.
Extrem ely Disagree 1 2 3 4 5 6 7 Extremely Agree
22. For me, perform ing a ll o f the above docum entation activities fo r one o f my patients in the next 2 weeks
is:
Extrem ely D iffic u lt 1 2 3 4 5 6 7 Extremely Easy
N ext Page
191
23. I intend to perform a ll o f the above documentation activities fo r one o f m y patients in the next 2 weeks.
Extrem ely U n lik e ly 1 2 3 4 5 6 7 Extremely Likely
V. Practice E n viro n m e n t:
I. The average number o f prescriptions you personally are involved w ith (dispensing/ consulting on) during a workday:
_R i's in a ho u r day
( N u m b e r o f p r e s c r ip t io n s ) ( N u m b e r o f h o u rs /d a y )
2. T his section asks about the adequacy o f resources in the pharmacy where you work to help perform pharmaceutical
care activities. Please use the fo llo w in g scale to rate the adequacy o f each type o f resource (Scale 1-6).
1 - Very Poor 2 - Poor 3 - Fair 4 - Good 5 - Very Good 6 - E xcellent
a) _____ A n area in the pharmacy where you can counsel o r ta lk w ith patients in private o r sem i-private manner
(yo u r conversations cannot be easily overbeard by other individuals).
b) _______ A com puter system which helps you store patient data and screen fo r drug-related problems.
c) _______ A com puter system which helps you develop patient care plans and evaluate outcomes.
d) _____ Trained pharmacy personnel that can perform some o f your tasks so that you can spend more tim e on
pharm aceutical care activities.
e) _____ Y o u r s k ills to provide pharmaceutical care services
V I. B a c k g ro u n d In fo r m a tio n :
1. When were you bom? 19__
2. W hat is yo u r gender? O M ale O Female
3. W hat is yo u r E thnic o r Racial Background?

O W h it e / C a u c a s ia n O B la c k /A fr ic a n A m e r ic a n O H is p a n ic
O O r ie n t a l/ A s ia n O A m e r ic a n I n d ia n O O th e r
4. W hat are you r degrees and/or training? (Check a ll that apply)

O BS O P h a r m D (1 s t d e g re e ) O P h a rm D ( p o s t B .S .) O P h a r m a c y R e s id e n c y
O MS O M BA O PhD O O t h e r ________________
5. When were you firs t licensed as a Pharmacist? 19__
6. W hat is yo u r m arital status?

O S in g le ( n e v e r m a r r ie d ) O S in g le ( s e p a r a t e d / d iv o r c e d ) O M a r r ie d O W id o w e d
7. W hat are the county & Z ip code o f the c ity where you have your prim ary place o f employment:
C o u n t y _________________________ Z i p _________________________
T han k you. Please re tu rn to:

T his num ber is fo r fo llo w up B ernard S orofm an, College ofP h arm acy
A nd can be erased fo r anonym ity Iowa C ity , IA 52242
192
A P P R O V E D B Y IR B -0 1 (B io m e d ic a l)
IR B ID N o .: 2 0 0 0 1 1 0 5 4
A P P R O V A L D A T E : 11/280000
E X P IR A T IO N D A T E : 11/280001
T h e u n iv e r s it y o f Io w a
[Initial Letter for Pilot Study]
November 2000
«First» «Last»
«Address 1»
«Address2»
«City», «State» «ZIP»
Dear Pharmacist:
As you know, the pharmacy profession is moving toward providing more patient-oriented care. We are
studying the effects o f the pharmacist’s personal style and the environment on their decisions to provide patient-
oriented care. The results o f this study can contribute directly to the profession o f pharmacy by designing
programs and systems that better fit practices. We are looking for ways to help our profession meet the needs o f
society. Your input can guide professional organizations to establish educational programs to facilitate your
provision o f patient-oriented care. The University o f Iowa College o f Pharmacy would like to invite you to
participate in a scientific research study.
You are one o f 50 people selected by chance from the pharmacists who live in Iowa to represent
pharmacists in Iowa. You w ill receive a survey questionnaire within 7 days after receiving this letter.
A t that time, you can respond anonymously to the questionnaire by erasing the number on the back o f
the form. The fact that you participated at all will be confidential. No one in this study w ill be identified
individually.
I would be happy to send you a summary o f the results, so please let me know i f you would like them. I
hope you w ill find this study interesting.
Sincerely
Bernard Sorofman, Ph.D., R.Ph.
College of Pharmacy Division of Clinical and Administrative Pharmacy S S 1 5 P H A R Iowa City. Iowa 52242-1112 319/335-8838 FAX 319/353-5646
193
A P P R O V E D B Y IR B -0 1 (B io m e d ica l)
IR B ID N o .: 2 0 0 0 1 1 0 5 4
A P P R O V A L D A T E : 11/28/2000
E X P IR A T IO N D A T E : 11/28/2001
[Cover Letter for Pilot Study]
November 2000
«First» «Last»
«Address 1»
«Address2»
Dear Pharmacist:
A few days ago you received a letter about our research project on the influences on patient-oriented
care. You were selected randomly from pharmacists living in Iowa. Your participation is important as you
represent a number o f pharmacists who were not selected to participate. You can respond anonymously by
erasing the number on the back o f the form. Individual responses w ill be kept in strict confidence. All
participation is voluntary. There is no penalty to anyone who decides not to participate. You may skip any
questions on the survey, which you do not wish to answer.
No one in this study w ill be identified individually and there are no known risks for participation. There
w ill be time costs for you as you take time to complete the questionnaire. Even though there is no direct benefit
to you, the results from this study can contribute to the sciences o f personality psychology, social psychology,
and pharmacy. This study w ill be the first to examine pharmacists’ personality traits and their relationship to
attitudes and practice environments, particularly as they relate to providing patient-oriented care. This study
will, therefore, directly apply to the profession of pharmacy.
Though the survey may look lengthy, it should only take about 12-15 minutes to complete. Please drop
me a note i f you want me to send you a summary o f the results o f our study.
I know your time is valued. Although I cannot pay each pharmacist to thank them for their time, you are
eligible for a drawing o f $100 Barnes & Noble bookstore gift certificate. Using the confidential ID number, it
w ill be drawn in the next 2 weeks. Please complete and return the enclosed survey to us.
Thank you for participating. Do not hesitate to contact with comments or questions: 319/335-8838; fax:
319/353-5646; E-mail: bemard-sorofman@uiowa.edu. Questions about the rights o f research subjects may be
addressed to the Human Subjects Office, 300 C M AB, The University o f Iowa, Iowa City. IA 52242, (319) 335-
6564.
Sincerely
College o f Pharmacy Division o f Clinical and Adm inistrative Pharmacy S 515 PHAR Iowa C ity. Iowa 52242*11 12 319/335-8838 F A X 319/353-5646
A P P R O V E D B Y IR B -0 1 ( B io m e d ic a l)
1R B ID N o .: 2 0Q 0110 S 4
A P P R O V A L D A T E : 11/28/2000
E X P IR A T IO N D A T E : 11/28/2001
Follow -up Postcard for Pilot Study
Pharmacist Address
Dear C olleague
Recently, you received a survey about the influences on patient-oriented care.
T o date I have not received your com pleted questionnaire.
Please consider doing so today.
Y o u r participation w ill contribute to a more accurate representation o f Iowa Pharmacists
Thank you.
Bernard Sorofm an
S5 5 l PHAR
College o f Pharmacy
Io w a C ity. IA 5 2 2 4 2 -I I 12
195
A P P R O V E D B Y IR B -0 1 (B io m e d ic a l)
IR B ID N o .: 2 0 0 0 1 1 0 5 4
A P P R O V A L D A T E : 11/28/2000
E X P IR A T IO N D A T E : 11/28/2001
[Initial Letter for Full Study]
December 2000
«First» «Last»
«Address 1»
«Address2»
Dear Pharmacist:
As you know, the pharmacy profession is moving toward providing more patient-oriented care. We are
studying the effects o f the pharmacist’s personal style and the environment on their decisions to provide patient-
oriented care. The results o f this study can contribute directly to the profession o f pharmacy by designing
programs and systems that better fit practices. We are looking for ways to help our profession meet the needs o f
society. Your input can guide professional organizations to establish educational programs to facilitate your
provision of patient-oriented care. The University o f Iowa College o f Pharmacy would like to invite you to
participate in a scientific research study.
You are one of 600 people selected by chance from the pharmacists who live in Iowa to represent
pharmacists in Iowa. You w ill receive a survey questionnaire within 7 days after receiving this letter.
A t that time, you can respond anonymously to the questionnaire by erasing the number on the back of
the form. The fact that you participated at all w ill be confidential. No one in this study w ill be identified
individually.
I would be happy to send you a summary o f the results, so please let me know i f you would like them. I
hope you will find this study interesting.
Sincerely
College o f Pharmac} Divtsion o f Clinical and Adm inistrative Pharmacy S 515 PHAR Iowa City. Iowa 52242-1112 319/335-8838 F A X 319/353-5646
196
A P P R O V E D B Y IR B -01 (B io m e d ic a l)
IR B ID N o .: 2 0 0 0 1 1 0 5 4
A P P R O V A L D A T E : 11/20/2000
E X P IR A T IO N D A T E : 11/28/2001
T H E UNIVERSITY OF IOWA
[Cover Letter for Full study)

December 2000
«First» «Last»
«Address 1»
«Address2»
Dear Pharmacist:
A few days ago you received a letter about our research project on the influences on patient-oriented
care. You were selected randomly from pharmacists living in Iowa. Your participation is important as you
represent a number o f pharmacists who were not selected to participate. You can respond anonymously by
erasing the number on the back o f the form. Individual responses w ill be kept in strict confidence. A ll
participation is voluntary'. There is no penalty to anyone who decides not to participate. You may skip any
question on the survey which you do not wish to answer.
No one in this study w ill be identified individually and there are no known risks for participation. There
will be time costs for you as you take time to complete the questionnaire. Even though there is no direct benefit
to you, the results from this study can contribute to the sciences o f personality psychology, social psychology,
and pharmacy. This study w ill be the first to examine pharmacists’ personality traits and their relationship to
attitudes and practice environments, particularly as they relate to providing patient-oriented care. This study
will, therefore, directly apply to the profession o f pharmacy.
Though the survey may look lengthy, it should only take about 12-15 minutes to complete. Please drop
me a note i f you want me to send you a summary o f the results o f our study.
1 know your time is valued. Although I cannot pay each pharmacist to thank them for their time, you are
eligible for a drawing for one o f the two $100 Bames & Noble bookstore gift certificates. Using the confidential
ID number, one w ill be drawn in the next 2 weeks and the other w ill be drawn at the end o f the study. Please
complete and return the enclosed survey to us.
addressed to the Human Subjects Office, 300 C M A B , The University o f Iowa. Iowa City, IA 52242, (319) 335-
6564.
Sincerely
College o f Pharmacy Division ofCltm cal and Admimsuauve Pharmacy S 515 PH AR lovva C ity. Iowa 522 42-11 12 319 /3 3 5 -8 8 3 8 FA X 319/353-5646
197
A P P R O V E D B Y IR B -01 (B io m a d ica l)
IR B ID N o .: 2 Q 0 0 1 1 0 5 4
A P P R O V A L D A T E : 11/28/2000
E X P IR A T IO N D A T E : 11/28/2001
Fo llow -up Postcard for Full Study
Pharmacist Address
D ear Colleague
Recently, you received a survey about the influences on patient-oriented care
To date I have not received your completed questionnaire
Please consider doing so today.
You r participation w ill contribute to a more accurate representation o f Iow a Pharmacists.
Thank you.
Bernard Sorofman
S 551 P H A R
College o f Pharmacy
Io w a C ity . IA 52242-1112
198
A P P R O V E D B Y IR B -0 1 (B io m e d ica l)
IR B ID N o .: 2 0 0 0 1 1 0 5 4
A P P R O V A L D A T E : 11/28/2000
E X P IR A T IO N D A T E : 11/28/2001
T H E UNIVERSITY OF IOWA
[Letter Sent with Follow-up Questionnaire]
Januarv 2001
«First» «Last»
«Address 1»
«Address2»
Dear Pharmacist:
About three weeks ago, I wrote to you seeking your input on research o f influences on patient-oriented
care. As o f today, I have not received your completed questionnaire. The large number o f questionnaires
returned is very encouraging. But, whether our results will be able to accurately represent Iowa pharmacists
depends upon you and the others who have not yet responded. Your input is critical to the validity o f the study.
I am writing to you again because of the significance o f each questionnaire. Your name was drawn by a
random sampling process. In order for information to be truly representative o f all Iowa pharmacists, it is
essential that all persons in the sample return their questionnaires.
Individual responses will be kept confidential and the results will be presented as aggregate numbers.
Though the questionnaire may look lengthy, it should take about 12-15 minutes to complete. You can respond
anonymously by erasing the number on the back o f the form or tearing it off.
Although I cannot pay each pharmacist for his/her time, there will be a random drawing for S100 Barnes
& Noble bookstore gift certificate at the end o f this study. You are eligible for this drawing. Please complete and
return the enclosed survey to us.
addressed to the Human Subjects Office, 300 C M A B , The University o f Iowa, Iowa City, IA 52242, (319) 335-
6564.
Sincerely
College o f Pharmacy Division o fC iin tca l and Administrative Pharmacy S 515 P H A R Iowa City. Iowa 5 2 2 4 2 -1 112 319/335-883& F A X 319/353-5646
CODE BOOK
IN F LU E N C E S O N P H A R M A C E U T IC A L C AR E
1. Please check one item that best describes your employment setting.
O Com m unity Pharmacy (in d e p jsm a ll chain) (# prescriptions/day;__________ )
O Com m unity Pharmacy (chain, >10 units) (# prescriptions/day:__________ )
O C lin ic Pharmacy (# prescriptions/day;__________ )
O Hospital Pharmacy (# beds:____________________ )
O Nursing Home/Long Term Care (# patients/day:______________ )
O O ther (describe):_____________________ (# patients/day o r U prescriptions/day :_
V ariable name: Variable label: Values and value labels:

SET! Practice setting type 1 = Com m unity Pharmacy (indepVsmall chain)
2 = Com m unity Pharmacy (chain, >10 units)
3 = C lin ic Pharmacy
4 = Hospital Pharmacy
5 = Nursing Home/Long Term Care
6 = Other (describe):
Blank = M issing data
V ariable name: Variable label: Values and value labels:

SETNUM 1 Number o f prescriptions/day, ifbeds, o r # Num ber
patients/day Blank = M issing data
2. I f you have ownership (equity) in your pharmacy, please note the extent o f your ownership:
%
Variable name: Variable label: Values and value labels:

O W N ER2 Extent o f the ownership Number (% o f extent o f the ownership)
3. W hich o f the follow ing best describes your current position?

O Manager o r D irector O Assistant/Associate Manager o r Director
O Supervisor O Staff/Em ployee Pharmacist
O Resident/Fellow/Post-graduate trainee O Other (specify)____________ t

PO SIT3 Current position 1 Manager o r D irector
2 Assistant/Associate Manager o r Director
3 Supervisor
4 StafFEmpIoyee Pharmacist
5 Resident/Fcllow/Post-graduate trainee
6 Other (specify)
200
L Please indicate how you see yourself. We realize that some questions are hard to answer; however,
please do the best you can to make an accurate rating (Place one o f the 5 numbers tha t applies to you on
the lin e next to each statement).
For example. I f you strongly agree that you are talkative, place number 5 on the lin e next to the
statem ent
I - S trongly Disagree 2 - Disagree 3 - Neutral 4 - Agree 5 - S trongly Agree
I seemyselfassomeone who......
1. is talkative. 23. R tends to be lazy.
2. R tends to fin d fault w ith others. 24. R is em otionally stable, not easily upset.
3. does a thorough job. 25. is inventive.
4. is depressed, blue. 26. has an assertive personality.
3. is original, comes up w ith new ideas. 27. R can be cold and aloof.
6. R is reserved. 28. _ perseveres u n til the task is finished.
7. is helpful and unselfish. 29. can be moody.
8. R can be somewhat careless. 30. _ . values artistic, aesthetic experiences
9. R is relaxed, handles stress w e ll. 31. R is sometimes shy. inhibited.
10. is curious about many d iffe re n t things. 32. _ is considerate and kin d to almost everyone
11. is fu ll o f energy. 33. . ,. does things e ffic ie n tly .
12. R starts quarrels w ith others. 34. R remains calm in tense situations.
13. is a reliable worker. 35. R prefers work tha t is routine.
14. can be tense. 36. is outgoing, sociable.
15. is ingenious, a deep thinker. 37. R is sometimes rude to others.
16. generates a lo t o f enthusiasm. 38. makes plans and follow s through w ith them
17. . has a forgiving nature. 39. . . gets nervous easily.
18. R tends to be disorganized. 40. likes to reflect, play w ith ideas.
19. worries a I o l 41. R has few a rtistic interests.
20. has an active im agination. 42. likes to cooperate w ith others.
21. R tends to be q u ie t 43. R is easily distracted.
22. is generally trusting. 44. . is sophisticated in art. music, or literature.
201

I seemyselfassomeone who__
P IE Talkative. I = Strongly Disagree
P 2 A /P 2 A r Find fa u lt 2 = Disagree
P3C Thorough job. 3 = Neutral
P4N Depressed. 4 = Agree
P 50P 5 O riginal. 5 = Strongly Agree
P6E / P 6E r Reserved. Blank = m issing data
P7A H elpful and unselfish.
P 8 C /P 8 C r Careless. (reverse score on items: 2 ,6 .8 , 9.
P 9 N /P 9 N r Relaxed. 12. 1 8 ,2 1 ,2 3 ,2 4 ,2 7 ,3 1 ,3 4 ,3 5 ,
P10O Curious. 3 7 ,4 1 ,4 3 )
PUE Full o f energy.
P 12A / P 12A r Quarrels.
P I3 C Reliable.
P14N Tense.
P I5 0 Ingenious.
P16E Enthusiasm.
P17A Forgiving.
P 18C /P 18C r Disorganized.
P I9 N Worries.
P20O Imagination.
P 2 IE /P 2 IE r Q uiet
P22A Trusting.
P23CV P23Cr Lazy.
P24N / P24Nr Em otionally stable.
P 250 Inventive.
P26E Assertive.
P 27A / P 27A r Cold and aloof.
P28C Perseveres.
P29N Moody.
P30O Aesthetic experiences.
P 31E /P 31E r Shy.
P32A Considerate.
P33C E fficient.
P34N / P34Nr Calm in tense situations.
P3SO/ P3SOr Prefers routine w ork.
P36E Sociable.
P37A/ P 37A r Rude to others.
P38C Makes plans.
P39N Nervous easily.
P40O Play w ith ideas.
P 410/ P 410r A rtistic interests.
P42A Cooperative.
P43C7 P 43C r Distracted.
P 440 Sophisticated in a rt.
202

EXTR A Extraversion Num ber (1-5)
= Mean (P IE . P6E. P11E. P16E, P21Er, P26E. P31Er, P36E)
AG REE Agreeableness Number (1-5)
= Mean (P2Ar. P7A, P12Ar, P17A. P22A. P27Ar. P32A, P37Ar. P42A)
CONSCI Conscientiousness Number (1-5)
= Mean (P3C, P8Cr, P13C, P I8C r, P23Cr, P28C. P33C, P38C, P43CD
NEURO Neuroticism Number (1-5)
= Mean (P4N, P9Nr, P14N, P19N, P24Nr. P29N, P34Nr, P39N)
OPEN Openness .Number (1-5)
= Mean (P 50, P10O, P150. P20O, P250. P30O. P 350r, P40O. P410r,
P440)
II. P atient Assessment A ctivitie s:
T hink about the last five patients o f yours who presented a re fill prescription used
to treat a chronic condition such as asthma, diabetes, o r hypertension. Please
indicate how many o f these fiv e patients you provided the follow ing activities.
(Scale: 0-5, please put the number in the blank in front o f the question).
1A skin g the patient questions to assess actual patterns o f use o f the medication.
2.Asking the patient questions to find out i f he o r she m ight be experiencing drug-related problems.
3 A skin g the patient questions to find out about the perceived effectiveness o f drugs he o r she was taking.
4A sking the patient questions to ascertain whether the therapeutic objective^) was(were) being reached.

B1 Assess actual patterns o f m edication use Number (0-5)
Blank = m issing data
B2 Find out drug-related problems Number (0-5)
Blank - m issing data
B3 Find out about effectiveness o f taking drugs Number (0-5)
B4 Ascertain the therapeutic objective Number (0-5)
Blank = missing data
Questions 5-8 refer to patients who presented a re fill prescription used to treat a
chronic condition such as asthma, diabetes, o r hypertension. Patient assessment
activities mean fou r activities from questions 1-4 above.
5. M y opinion about perform ing a ll o f the above patient assessment activities fo r one
o f m y patients in the next 2 weeks is: (circle the number that apply to you)
Extrem ely Unfavorable 1 2 3 4 5 6 7 Extrem ely Favorable

ATS A ttitude: natient assessment activities Number (1-7)
A nchor Extrem ely Unfavorable - Extrem ely
Favorable
203
6. Most people who are important to me think I should perform all o f the above patient
assessment activities for one of my patients in the next 2 weeks.
Extremely Disagree 1 2 3 4 5 6 7 Extremely Agree
Variable name: V ariable label: Values and value labels:

SN6 Subiective norm : oatient assessment a ctivities Num ber (1-7)
A n ch o r Extremely Disagree - Extrem ely Agree
7. For me, perform ing a ll o f the above patient assessment activitie s fo r one o f m y patients in the next 2
weeks is:
Extrem ely D iffic u lt 1 2 3 4 5 6 7 Extremely Easy

P7 Perceived behavioral control: Datient Num ber (1-7)
assessment activities. A n ch o r Extremely D iffic u lt - Extrem ely Easy
8. I intend to perform a ll o f the above patient assessment activities fo r one o f m y patients in the next 2
weeks.
Extrem ely U n lik e ly 1 2 3 4 5 6 7 Extremely Likely

IN 8 Intention: oatient assessment activities. Number (1-7)
A n ch o r Extremely U nlike ly - Extrem ely Likely
III. D rug-related P roblem Resolution A ctivitie s:
Now, think about the last fiv e patients o f yours who you discovered were experiencing drug-related
9. M onitoring drug therapy to id en tify drug-related problems.

lO.Im plem enting a strategy to resolve (or prevent) the drug-related problems.
1 l.Follow ing-up the plan established fo r resolving the patient’s drug-related problems.

B9 Id e n tify drug-related problems Number (0-5)
BIO Im plem enting a strategy for drug-related problems Number (0-5)
B ll Follow ing-up resolving plan fo r drug-related problems Number (0-5)
Questions 12-15 refer to patients who you discovered were experiencing drug-related problems.
Implementation o f therapeutic objectives and m onitoring plan a ctivitie s mean three activities from questions
9-11 above.
204
12. My opinion about performing all of the above drug-related resolution activities
for one o f my patients in the next 2 weeks is:
Extremely Unfavorable 1 2 3 4 5 6 7 Extremely Favorable

AT12 A ttitu de : drug-related resolution activities Number (1-7)
A n ch o r Extrem ely Unfavorable - Extrem ely
Favorable
13. M ost people who are im portant to me th in k I should perform a ll o f the above drug-related resolution
activities fo r one o f m y patients in the next 2 weeks.
Extrem ely Disagree 1 2 3 4 5 6 7 Extrem ely Agree

SN13 Subjective norm : drug-related resolution activities Number (1-7)
A nch or Extrem ely Disagree - Extrem ely Agree
14. For me, perform ing a ll o f the above drue-related resolution activities fo r one o f m y patients in the
next 2 weeks is:
Extrem ely D iffic u lt 1 2 3 4 5 6 7 Extrem ely Easy

P14 Perceived behavioral control: drug-related resolution activities Number ( I -7)
Anchor. Extremely D iffic u lt -
Extremely Easy
15. I intend to perform a ll o f the above drug-related resolution activities fo r one o f m y patients in the
next 2 weeks.
Extrem ely U n like ly 1 2 3 4 5 6 7 Extrem ely Likely

IN 15 Intention: drug-related resolution activities Number (1-7)
A nch or Extremely U nlike ly -
Extremely Likely
205
IV . Docum entation A c tiv itie s :
Next, think about the last five patients o f yours who presented a prescription fo r new medications used to
treat a chronic condition such as asthma, diabetes, o r hypertension. Please indicate how many o f these
fiv e patients you provided the fo llo w in g activities.
16. Documenting inform ation about the patient’s medical conditions on w ritten records or computerized
notes or by other form al mechanisms in a form that could be read and interpreted by another health
care practitioner in your absence.
17. Documenting a ll m edications currently being taken by the patient on the w ritten records or
computerized notes o r by other form al mechanisms in a form that could be read and interpreted by
another health care practitioner in your absence.
Now, think about the last five patients o f yours who you discovered were experiencing drug-related
18. Documenting the drug-related problems, potential o r actual, on w ritten notes.

19. Documenting any intervention made on the patient’s pro file , prescription, report, or medical order in
a form that could be read and interpreted by another health care professional.

B16 Docum enting patient’s medical conditions Num ber (0-5)
B17 Docum enting a ll currently medications Number (0-5)
B18 Docum enting the drug-related problems, potential o r actual Number (0-5)
B19 Documenting any intervention Number (0-5)
Questions 20-23 refer to patients who presented a prescription fo r new medications used to treat a chronic
condition such as asthma, diabetes, o r hypertension or who you discovered were experiencing drug-
related problems. Documentation activities mean the four activities from questions 16-19 above.
20. M y opinion about perform ing a ll o f the above documentation activities fo r one o f m y patients in the
next 2 weeks is:

AT20 A ttitude: documentation activities Number (1-7)
Anchor. Extremely
Unfavorable - Extremely
Favorable
21. Most people who arc important to me think I should perform all o f the above documentation
activities for one o f my patients in the next 2 weeks.
Extremely Disagree 1 2 3 4 5 6 7 Extremely Agree

SN21 Subjective norm: documentation activities. Num ber (1-7)
A nchor: Extrem ely Disagree
- Extrem ely Agree
22. For me, perform ing a ll o f the above documentation activities fo r one o f m y patients in the next 2
weeks is:
Extrem ely D iffic u lt I 2 3 4 5 6 7 Extrem ely Easy

P22 Perceived behavioral control: documentation Num ber (1-7)
activities A n ch o r Extrem ely D iffic u lt
- Extrem ely Easy
23. I intend to perform a ll o f the above documentation activities fo r one o f m y patients in the next 2
weeks.
Extrem ely U nlike ly 1 2 3 4 5 6 7 Extrem ely Likely

IN 23 Intention: documentation activities Num ber (1-7)
A n c h o r Extrem ely U nlikely
- Extrem ely L ik e ly

ATT A ttitude toward pharmaceutical care Num ber (1-21)
= SUM (AT5. A T I 2. AT20)
SNORM Subjective norm Num ber (1-21)
= SUM (SN6, SN13, SN21)
PBC Perceived behavioral control Num ber ( I -2 1)
= SUM (PC7, P C I4, PC21)
IN T E N Intention Num ber (1-21)
= SUM (IN 8, IN 15, IN23)
PC Pharmaceutical care provision Num ber (0-55)
= SUM (B I. B2, B3, B4, B9.
B IO , B 1 1, B16, B17, B18,
B19)
207
V. P ractice E nvironm ent:
I . The average num ber o f prescriptions you personally are involved w ith (dispensing/ consulting on)
during a workday:
Rx’« in a _______h o u r day
(N um ber o f prescriptions) (N um ber o f hours/day)

Rx Number o f prescriptions Number
B lank = missing data
H our Num ber o f hours/day Number
W ORK W orkload Number
(R x/ H o ur) (The average number o f prescription a day / number o f
hour day)
1. This section asks about the adequacy o f resources in the pharmacy where you w ork to help perform
pharmaceutical care activities. Please use the follow ing scale to rate the adequacy o f each type o f
resource (Scale 1-6).
1 - Very Poor 2 - Poor 3 - Fair 4 - Good 5 - V ery Good 6 —Excellent
a) _____ An area in the pharmacy where you can counsel o r ta lk w ith patients in private o r
semi-private manner (your conversations cannot be easily overheard by other
individuals).
b) _____ A computer system w hich helps you store patient data and screen fo r drug-related
problems.
c) _____ A computer system w hich helps you develop patient care plans and evaluate
outcomes.
d) _____ Trained pharmacy personnel that can perform some o f your tasks so that you can
spend more tim e on pharmaceutical care activities.

RE_a Private area Number (1-6)
1 = V ery Poor
RE_b Computer system: store patient data and screen fo r 2 = Poor
drug-related problems 3 = Fair
REc Computer system: develop patient care plans and 4 = Good
evaluate outcomes 5 = Very Good
RE_d Trained pharmacy personnel 6 = Excellent
REc Pharmacist s k ill
RESOUR Adequacy o f resources Num ber (5 -30)

= (Re_a +Re_b +Re_c +Re_d)
208
V I. B a c k g ro u n d In fo r m a tio n :
I .W h e n w e re y o u b o m ? 19 ____
2 . W h a t is y o u r g e n d e r ? O M a le O F e m a le
3 . W h a t is y o u r E t h n i c o r R a c ia l B a c k g r o u n d ?
O W h it e / C a u c a s ia n O B l a c k / A f r i c a n A m e r ic a n O H is p a n ic
O O r ie n t a l/ A s i a n O A m e r ic a n I n d i a n O O th e r
4 . W h a t a r e y o u r d e g re e s a n d / o r t r a i n in g ? ( C h e c k a l l t h a t a p p ly )
O B S O P h a rm D ( 1 s t d e g re e ) O P h a r m D ( p o s t B .S .) O P h a r m a c y R e s id e n c y
O M S O M B A O PhD O O t h e r _________________
5 . W h e n w e r e y o u f i r s t lic e n s e d a s a P h a r m a c is t? 19
6 . W h a t is y o u r m a r i t a l s ta tu s ?
O S i n g l e ( n e v e r m a r r ie d ) O S i n g l e ( s e p a r a t e d / d iv o r c e d ) O M a rr ie d O W id o w e d
7 .W h a t a re th e c o u n ty & Z ip c o d e o f th e c i t y w h e r e y o u h a v e y o u r p r im a r y p la c e o f
e m p lo y m e n t *
C o u n t y _________________________ Z i p __________________________

AG EI Age Num ber listed
B lank - missing data
SEX2 Gender 1 = Male
2 = Female
R AC E3 Ethnic or Racial Background 1 = White/Caucasian
2 = Black/A frican American
3 = Hispanic
4 —O riental/Asian
5 = American Indian
6 = O ther
BS4 B.S. degree 0 = not B.S degree
1 = B.S degree
PharD F4 PharmD (firs t degree) 0 = not PharmD (firs t degree)
1 = PharmD (firs t degree)
PbarDP4 PharmD (post B.S.) 0 = not PharmD (post B.S.)
1 = PharmD (post B.S.)
Phres4 Pharmacy Residency 0 = not Pharmacy Residency
1 = Pharmacy Residency
B lank - missing data
MS4 M.S. degree 0 = not M.S degree
1 = M .S degree
M BA4 M B A degree 0 = not M BA degree
1 = M B A degree
209

PhD4 PhD degree 0 = not PhD degree
1 = PhD degree
O th e r4 O ther degree 0 = not other degree
1 = other degree
Blank - missing data
Y R L IC 5 Num ber o f years licensed as a pharm acist number listed
M A R I6 M arital status 1 = Single (never married)
2 = Single (separated/divorced)
3 = Married
4 = Widowed
C O U N TY County code number 1*99
Z IP Z ip code code number
210
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A thesis submitted in partial fulfillment

Thesis supervisor: Associate Professor Bernard A. Sorofman

Bell & Howell Information and Learning Company

This is to certify that the Ph.D. thesis of

has been approved by the Examining Committee

It is extremely difficult and probably impossible to

persons who stood by me along the way and made immeasurable

my dissertation supervisor, for.his support, guidance, and

patience. Since my arrival at the College of Pharmacy at

skills from him and kept me going through some of the

detailed written and oral comments he and Dr. Karen Farris

several embarrassing errors and providing additional

many ways; to Courtenay Bouvier for her help in correcting

language in my thesis; and to Phil Potter for his help in

who responded to my survey; without them my thesis would

I am grateful to Dr. Rungpetch Sakulbumrungsil who

introduced me to the scholarship of the Thai Ministry of

University Affairs for Chulalongkorn University and

help from her, she provided prompt and supportive replies.

of my family while I was in Iowa. I also owe a number of

government for my study abroad: Dr. Chamnan Patarapanich,

Col. Lursak Mahasub, Pol. Lt. Col. Pimol Bumrung, Asst.

Thanaviriyakul, and Asst. Prof. Wanchai Treyaprasert.

Finally, one very special THANK YOU filled with all my

my sisters, Udomluck and Pakamart Kittisopee, and my

My cordial thanks goes out to each of you mentioned

Significance of the Study ................. 6

Over v i e w................................... 136

APPENDIX A. DESCRIPTIVE DATA OF I T E M S .............. 167

APPENDIX C. QUESTIONNAIRE, LETTERS, CODE B O O K ......... 187

2. Items for Measuring Extraversion ............... 51

3. Items for Measuring N e u r oticism................ 51

4. Items for Measuring Agreeableness.............. 52

9. Items of The Documentation D i m e n s i o n ............ 57

12. Items for Measuring Subjective N o r m ............ 64

13. Items for Measuring Perceived Behavioral

15. Item for Measuring W o r k l o a d ..................... 68

17. Pharmacists' Practice Characteristics .......... 85

18. Number of prescriptions, Patients, and Beds of

21. Pharmacists' Personality Characteristics

23. Practice Environment Characteristics........... 93

24. Reliability Coefficients for M e a s u r e s .......... 95

26. Multiple Regression Model Results: Hypothesis

28. Multiple Regression Model for Predicting

33. Multiple Regression Model Results from Post

35. Summary of The Full Model with Pharmacist

36. Regression Coefficients of Variables in The

41. Post Hoc Multiple Regression Model Results:

42. Post Hoc Multiple Regression Model for

43. Post Hoc Multiple Regression Model for

44. Results of Regression Model 1: Mediational

45. Results of Regression Model 2: Mediational

49. Descriptive Statistics for Individual Items of

54. Inter-item Correlations for Extraversion

57. Inter-item Correlations.for Neuroticism

1. The Hypothesized Model for Research Question 1 - 44

3. The Second Hypothesized Model for Research

4. The Hypothesized Model for Research Question 3 . 47