Jeroen van de Pol

28 Chapter 2.1 Methods Study design Cross-sectional study using a work-sampling technique based on self-reporting at random intervals was conducted with community pharmacists between January and July 2016. A smartphone application was developed to register the activities of participating pharmacists. The application randomly alerted pharmacists to record their activities five times between 9.00 and 19.00 hours each working day (within ± 60 minutes of 10.00, 12.00, 14.00, 16.00, and 18.00 hours).This timing was purposely chosen to register activities during the entire workday, while reducing the risk of registering activities with a daily cyclical nature. When presented with an alert, participants were asked to fill in their precise activity at that specific moment. The activities were registered in an online database. Participants could register activities directly after the initial alert or optionally until the end of the workday. After that, an alert was coded as missing. The time that elapsed between the alert and the actual registration of the activity was recorded. Participants were also asked to complete an online survey on baseline characteristics. The duration of this study lasted 6 weeks for each participant to ensure that activities with a monthly cyclical nature (e.g. the monthly billing cycle) would be recorded at least once during the observation period. Participants Community pharmacists were recruited through the Utrecht Pharmacy Practice network for Education and Research (UPPER), which includes approximately 1,200 of the in total 1,900 Dutch community pharmacies [23]. All registered community pharmacists in the UPPER network were informed about the study by means of a short announcement in the UPPER newsletter and a random selection of 400 community pharmacists was invited by e-mail. Mobile application development Categories and subcategories of activities were based on previous community pharmacy work-sampling studies performed in Northern Ireland [13,17] and were slightly modified to fit current Dutch pharmacy practice. Subsequently, five Dutch practicing community pharmacists tested a beta version of the application. Their feedback was used to define the final categories and subcategories (see table 1 and supplementary material table 1. They also deemed five alerts per workday acceptable. To prevent misclassification, a short description of the type of activities in each subcategory was provided (see supplementary material table 1).