Table 4.

Pharmacy users (CMOCs 10–13)

CMOC 10—trust the pharmacist as reliable information source25 61 85 136–138	When pharmacy users receive information about the COVID-19 vaccine from their community pharmacy (C), they are more likely to get the vaccine (O), because they trust community pharmacy as a source of reliable, accurate information (M).
	‘When patients were educated about influenza, herpes zoster, and pneumococcal vaccines as a result of a pharmacist-driven intervention in community pharmacies, they were influenced to receive the vaccination.’ (USA) 136 ‘Being able to address the public enquiries with accurate up-to-date information about the local situation and the overall infection progress is the key to build trustful relationship with them at troubled times.’ (Macau) 25
CMOC 11—trust the pharmacist to deliver responsive services7 18 26 27 30 31 35 42 43 54 71 74 86 96 108 109 139–149	When community pharmacies are trusted to make necessary service adaptations to ensure services are flexible, convenient and accessible (C), COVID-19 vaccine uptake is likely to be higher among pharmacy users (O) because the service is responsive to local needs (M).
	‘Pharmacists have always been the most accessible health care provider; this is especially true in the era of COVID-19…. While other professionals have closed their doors to patients, community pharmacies remained open to the public despite stricter lockdown restrictions. As highly trusted healthcare clinicians, community pharmacists play a vital role in closing the gaps that are exacerbated by the additional strain on the system and reduced access to healthcare providers.’ (Canada) 35 ‘Pharmacy flu vaccination services complement those provided by general practitioners to help improve overall coverage and vaccination rates for patients in at-risk groups. These services are highly accessed by patients from all socio demographic areas, and seem to be particularly attractive to carers, frontline healthcare workers, and those of working age.’ (Great Britain) 149
CMOC 12—access culturally sensitive services33 67 104 115 150	When community pharmacies leverage their community location and community–staff relationships (C), vulnerable populations, such as ethnic minorities, are more likely to use their services, including COVID-19 vaccination services (O), because they trust their local community pharmacies to provide culturally sensitive service (M).
	‘Research continues to highlight that patients who are medically under-served have poorer inequitable access to health care due to them experiencing greater physical barriers to accessibility, encountering poorer patient-professional communication and are significantly disadvantaged where a service is not tailored to their unique needs or preferences.’ (Great Britain) 151 ‘I think over the years what’s happened is nationally it’s almost like everything has to be the same, which then doesn’t work because it doesn’t accommodate all the little variations…So we need to go back and in each individual pharmacy, gear it towards the population that it is meant to be meeting the needs of.’ (Pharmacist caring for ethnic minority community—Great Britain) 151
CMOC 13—receive private and confidential services7 43 45 83 152–154	When community pharmacies make provisions for privacy (C), pharmacy users are more likely to use their services (O), because they are reassured about confidentiality (M).
	‘If there was something not right…the first thing I would do is make an appointment with a doctor. I wouldn’t do and talk to somebody over a pharmacy counter.’ (Great Britain) 45 ‘Privacy, confidentiality and dignity are all vital elements of a trusting relationship between healthcare professionals and their patients…. In terms of privacy, the quality was perceived by the participants to include a confidential room that enabled private consultations.’ (Great Britain) 7

CMOC, context-mechanism-outcome configuration.