Table 3. Major Themes and Findings on Community Pharmacy Engagement in Diabetes Prevention From Key Informant Interviews With Pharmacy Executives, 2018.

Theme	Explanation of Theme	Finding	Representative Quote
Financial feasibility	Initiation of services is more likely if initial financial support is received and likely to result in a sustainable business model.	Financial feasibility and sustainable reimbursement models are critical for adoption of diabetes prevention programs, with grant funding a catalyst most commonly used by independent pharmacies and grocery stores with pharmacies.	An independent pharmacy participant said, “[W]e obviously are testing the waters and figuring things out in this beta version. And hopefully we’ll have all the kinks ironed out for our second go, which would be when we are Medicare-payment eligible.”
Consumer participation	Consumer buy-in and demand for services, actual or perceived; initiation and retention in diabetes prevention services is paramount.	Inadequate consumer participation in diabetes prevention programs is problematic, but pharmacies are committed to solving this issue.	An independent pharmacy participant said, “A lot of people don’t want to participate, they don’t want to take the time.”
Operational fit	Diabetes prevention services fit within the existing operational structure of a pharmacy and allow the pharmacy to maximize its personnel and resources.	Operational fit is important, and appropriate use of nonpharmacists is essential to adoption and success of diabetes prevention programs.	A traditional chain pharmacy participant explained this decision process as follows: “Our workflow is designed to really generate large volumes of scripts [prescriptions] in a very standard and high-quality, safe way. And so, we do offer pharmacy interventions, and we take our pharmacist out of workflow to have conversations with patients, but . . . we’re really strategic . . . because there’s only so much time that the pharmacist has to have these conversations and conduct these interventions.”
Customer loyalty	A clearly articulated advantage against competition, and alignment of values, is key to a pharmacy’s adoption of diabetes prevention services.	Customer loyalty is a top advantage gained by pharmacy adopters of diabetes prevention programs, but specific characteristics of grocery stores that made delivery of those programs easier was an advantage not seen in other settings.	An independent pharmacy participant said patients feel valued and, “they can leave having learned about diabetes, and physically how to prevent it. And that, ultimately, promotes customer loyalty, which would then promote pharmacy shopping. It’s a domino effect.”
Expanded access and collaboration	Demonstrates and affirms expanded role and value of pharmacies to serve communities. Reaching those without health care access also drives initiation of services.	Pharmacies are focused on expanding health care access to at-risk populations and collaborating with health care teams.	One mass merchant participant said, “I think it’s a great public service, so raising awareness and helping to serve the patient has been really beneficial. I think it helps to engage our pharmacists in a way that they haven’t been engaged previously, and so that professional satisfaction to really have a meaningful clinical conversation with someone who’s unaware that they may be prediabetic.”