Table 3.

Themes derived from analysis of student reflections on value of Health and Wellness Project on student learning, knowledge, and skill development.

Main Themes (N) (Subthemes)	Explanation	Illustrative Quotations (Participant Number (#)
Knowledge Acquisition (22) (increased knowledge of project topic, topics outside defined project scope)	Students expressed learning in-depth knowledge preparing for their project and appreciated the ability to apply learned didactic knowledge to actual patients. Several commented on selecting a project topic that was either not heavily detailed in the didactic curriculum or was new, facilitating self-directed learning. By increasing patient/community contact, the project exposed students to queries outside their project scope, leading some to appreciate this challenge to their knowledge base. Students learned how to confirm information, research an unknown topic, or look up medication interactions for a specific patient and provide needed follow-up.	“There have already been new diabetes therapies out since I learned about them during my (therapeutics) course...Knowing the current therapies and factoring in individual factors of patients for each of these therapies will help me become a better pharmacist when I start practicing.” (#36) “This project has allowed me to research and learn more information about immunizations than any class during my academic career. I can now use this knowledge as I move forward in my pharmacy career, educating more and more patients.” (#18) “The project I had was very focused on allergies and the medications used to treat them, such as intranasal corticosteroids, antihistamines, and decongestants, but many patients have questions regarding their over-the-counter medications for other areas like pain, digestive health, cough, injuries, dry eyes etc.” (#3)
Communication Skills Enhancement (40) (application of verbal communication skills, adaption of verbal communication to individual patients, role of communication to initiate project, use of technology to enhance communication)	Reflections demonstrated student application of a myriad of verbal and non-verbal communication skills. Students practiced conducting patient interviews to gather past medical/medication histories and discover patient preferences while learning to ask the right questions in effective ways, using a friendly tone with easy-to-understand terminology, and practicing better active listening skills. Students tailored verbal communication to the individual, considering health literacy and prior topic knowledge to “meet the patient where they are.” Several described the verbal and non-verbal (eye contact, smiling) skills needed to draw the patient in for discussion. A few students described the utilization of technology for patient learning, including live animations on slide presentations, portable technology for health/medication topics, or selecting patient-oriented medication adherence aids.	“I feel that this (HWP) will improve how I counsel patients as I can tailor the counseling specifically towards a patient. What may be an important counseling point for one patient may be different for another patient. While it is important to have a mental checklist of counseling points, it is more important to gauge what the specific patient knows.” (#25) “The biggest lesson I learned was patient communication. … I learned how to effectively communicate with different patients. There are some patients more familiar with their health and medical language while others had trouble understanding their medications and health. Once recognizing the extent of the patient’s understanding, I would adjust my language and how I went about explaining and answering their questions.” (#14) “I was able to make eye contact or draw almost all customers’ attention that passed by…. All patients remarked how my poster design and presentation, as well as my persistent eye contact and smile drew them to at least check out what I had to offer at first.” (#43)
Patient-centered care (22) (tailoring recommendations to individual patients)	Students described actively participating in the selection and implementation of recommendations to individual patients, considering person-specific factors such as a preference for self-care, dosage forms, cost considerations, social determinants of health, and cultural factors. Student projects that were not medication or condition-specific but rather focused on either access to medications (selecting Medicare plans, cost savings programs) or adherence also described tailoring or customizing their recommendations to the specific patient needs, determinants, and preferences.	“This experience has allowed me to be more culturally sensitive and learn the demographic of those who are around me. During my rotation, the pharmacy was in an underserved location where many people did not have the resources to pay for the medications. While working on my project, I was able to incorporate/think about the costs of the recommendations. This notion of cultural/demographic sensitivity is something I will carry along with me for the rest of my rotations and pharmacy career.” (#5) “Each patient has different needs and different personalities. For my compliance aide HWP, for patients who were more technology inclined, I could recommend apps on their smartphones and for other patients I would recommend more physical strategies like pill boxes.” (#40) “Patient individualization is crucial when we help each patient. Every single one (who attended my Brown Bag event) had a different economic and social status that affected their medication selection which we have to take into account in order to maximize pharmacological and nonpharmacological therapy.” (#32)
Educator (65) (selecting educational strategy, adapting visual aids (poster, handouts) to the community, the role of visual aids to initiate interaction, reflecting on opportunities for improvement)	Preparing the project, students considered a wide range of factors, such as choosing or creating the visual aids to be used (flow charts, infographics, posters, handouts) and how to adapt them to their desired targeted audience (literacy, age, visual acuity). They considered which visuals would “catch the interest” of the shopper or patient to garner participation. Many reflected on ways they could expand or enhance the project either through the materials provided, its placement in workflow, the physical location of the intervention, or the selection of the targeted audience demonstrating learning.	“The project met the educator standard by using a plethora of visuals as summaries for patients. A table comparing symptoms of the flu and cold was used as a quick summary to differentiate the two conditions. Large visuals were used to attract patient attention such as an image of a Tylenol bottle which was easily recognizable… Patients commented that the visuals attracted their attention such as the large Tylenol image which gave patients a sense of familiarity… I learned that a simple poster board can be enough of a reminder to get patients to act.”(#25) “I determined the most effective and enduing ways to impart information was to display my poster in the waiting area of the pharmacy. Most patients have to wait for their prescriptions to be ready and while they would wait I’d notice they would read my poster and have follow-up questions. … If I noticed a patient reading my poster I’d ask if they have any questions or interested in receiving a vaccine.” (#20) “I think if I were to do this project again I would change the theme of the table every three days or so. This would offer the community more information on other topics that they may have been more interested in. Mental health has a stigma around it, so some saw that sign and were immediately uninterested.” (#6)