*2.3. Questionnaire*

An online questionnaire was developed to gather demographic data, data relating to roles and responsibilities and pre- and post-registration training. Specific data were obtained for workplace support, professional identity and delegation, to ascertain whether or not these were barriers and/ or enablers to current practice and future role development.

Standardised descriptors were used to categorise the type and size of pharmacy [11,12] —independent pharmacy; small chain (2–4 pharmacies); medium sized multiple (5–25 pharmacies); large multiple (over 25 pharmacies); supermarket pharmacy and other. A five-point Likert scale was used to rate agreemen<sup>t</sup> with statements relating to perceived barriers and enablers. (SD = strongly disagree; D = disagree; N = neither agree nor disagree; A = agree; SA = strongly agree. NA = not applicable was added where appropriate).

The wording of some Likert scale statements was reversed to reduce the risk of response bias [19]. Free text boxes were included at the end of each set of questions to enable participants to provide further comment and context [20]. The online questionnaire was piloted using three volunteers within the researcher's [RC] professional network and one of the supervisors (DJ), with expertise in questionnaire design. Revisions were made to improve the clarity of supporting information, the accuracy of rating scales and to resolve technical issues with how the survey was displayed (e.g., when responses to question 7 were filtered through to questions 8 and 9).

## *2.4. Interviews*

Semi-structured, one-to-one telephone interviews were undertaken to obtain further insight into community PT roles and the barriers and enablers experienced. Participants were sent a participant information sheet and provided written consent for the interview to be recorded. A semi-structured interview schedule was developed, based on the existing literature and in-depth knowledge of two authors (RC and DJ) of the pharmacy technician workforce. This was used to identify the main topics for discussion and ensure consistency. Open-ended questions and prompts based on potential

responses were prepared in advance to provide structure, whilst retaining some flexibility and allowing participants to determine the level of detail provided [21] (see Supplementary Materials). Interviewees were asked about their current roles, use of knowledge and skills in the workplace, e fficacy of initial education and training and any further training undertaken. The interview also explored workplace support, delegation and potential enablers and barriers to conducting their role. Interviews were audio recorded and transcribed verbatim.

#### *2.5. Sampling, Recruitment and Study Procedures*

The GPhC register data do not di fferentiate registrants by sector of pharmacy, so a specific sampling framework could not be identified. The number of CPTs in Wales was estimated based on data indicating that 6.8% of all PTs in the UK live in Wales [22], equivalent to 1586. Of those, it has been estimated that 53% of PTs work in the community pharmacy sector [23], which is equivalent to 841.

The online questionnaire was disseminated to all registered pharmacy technicians in Wales by the GPhC in January 2018 via e-mail. The launch of the questionnaire was advertised via multiple pharmacy related social media platforms, clearly stating that the questionnaire was intended for community pharmacy technicians only. An initial filter question was added to the questionnaire to avoid completion by non-community-based PTs (32 responders who were not CPTs were redirected to the end of the questionnaire). The GPhC sent two follow up e-mails in February and March, both of which increased response rates.

The questionnaire was hosted on Qualtrics © software. An open access web link was added to the e-mail message and social media posts. Responses were captured over a 2-month period between January and March 2018. Interview audio data were transcribed by Sterling Transcription ©, using Intelligent Verbatim (Standard Style).

### *2.6. Data Analysis*

Quantitative analysis was undertaken using the report function within Qualtrics software (Version 2018 of Qualtrics, Copyright © 2018 Qualtrics, Provo, UT, USA); e.g., to calculate frequency distribution of demographic and categorical data. Data were extracted from Qualtrics into Microsoft Excel (Excel 97–2004, Microsoft Corporation, Redmond, WA, USA) to calculate central tendencies for interval data; e.g., percentage time spent dispensing per week. Data were also extracted from Qualtrics to the Statistical Package for the Social Sciences (SPSS Version 25.0 2018, IBM Corp, Armonk, NY, USA). Cronbach's alpha analysis was undertaken to estimate the internal consistency (reliability) of the scales. Negatively worded items were reversed scored and items which contributed to a poor alpha score were excluded from the respective scale (i.e., Q31R etc.) Scales with Cronbach's alpha scores > 0.7 were deemed to have good internal reliability [23] and therefore total scale scores were calculated for the following scales: e fficacy of initial education (5 items), colleagues' understanding of training (2 items), workplace support (3 items), professional identity (3 items) and delegation (2 items). A Kruskal–Wallis test was used to compare responses from PTs across di fferent categories of pharmacy, for questions relating to workplace support, professional support, recognition of professional identity and use of delegation.

Qualitative content analysis was undertaken by manually coding free-text written comments from questionnaires into categories, e.g., specific job roles, with one exception where quantitative content analysis was undertaken to measure the number of participants who reported a change in role since qualifying as a pharmacy technician. Categories were then grouped together to identify key themes, e.g., areas of pharmacy practice. Interview data were transcribed and simplified using a process known as data reduction [24], to produce a chart summarizing responses to each of the research topics and to identify further explanatory or supporting data. Verbatim quotes were extracted from the interview data for illustrative purposes. Quotes include the participant number, category of pharmacy and year of qualification for context.
