**3. Results**

During phase one in 2017, 19 pharmacists, each from a separate individual pharmacy within the same chain, agreed to participate in the key informant interviews. One pharmacist declined to participate during the interview. During phase two in 2020, five of the original pharmacies that were contacted had a pharmacist who was willing to participate, and all five pharmacies still employed pharmacy technicians who administered immunizations. Participant demographics from 2017 [18] and 2020 are included in Tables 2 and 3.





\* No active immunizing technician for one month.

Qualitative analysis led to the following themes mapped back to each of Rogers' 5 Factors, which are intrinsic components associated with the adoption of an innovation. Specifics on Rogers' 5 Factors, relative advantage, compatibility, complexity or simplicity, trialability, and observability are described within the Methods section.

#### *3.1. Factor 1: Relative Advantage*

The relative advantage domain had one theme: improved flexibility towards creating a continuous workflow associated with immunizations administered within the pharmacy. This was reported by pharmacists in 2017 and confirmed by similar responses from 2020.

**Theme 1.** *Pharmacists believe having immunizing technicians improved the pharmacy workflow flexibility involved with immunizations.*


#### *3.2. Factor 2: Compatibility*

Compatibility is described as the assimilation of an innovation into a particular model. In this model the pharmacy technicians' compatibility with the newly provided service was highlighted by their supervising pharmacists.

**Theme 2.** *Pharmacists believe in choosing a confident and friendly technician to provide immunizations.*


• *"I think a lot of it's the technician's personality. I try and pick technicians who are really comfortable with it, and if they'll own it, those are the ones who are going to be most successful at it. That's what I would say to look for, when you choose technicians to do it look for ones that that's going to fit their personality type." (2020 Pharmacist 3)*

#### *3.3. Factor 3: Complexity or Simplicity*

The complexity or simplicity of introducing a newly immunization-trained pharmacy technician into the workflow should be considered by stakeholders. The level of effort required to train and observe does not immediately improve workflow. However, after comfort is established by the supervising pharmacist the level of complexity for each immunization is reduced.

**Theme 3.** *Supervising pharmacists believe the innovation of having a technician capable of immunizing within the workflow helps to better prioritize their time.*


#### *3.4. Factor 4: Trialability*

Trialability helps stakeholders to determine how easily an innovation can be adopted. By testing for this factor, adopters can anticipate certain pitfalls to avoid. After implementation and trial, the barriers of the new innovation should be considered to determine whether stakeholders should adopt the new practice. Ultimately, one recurrent theme was highlighted by the key informant interviews.

**Theme 4.** *Pharmacists wanted more immunization-trained pharmacy technicians in their pharmacies.*


#### *3.5. Factor 5: Observability*

Transparency and the observability of the opinions of supervising pharmacists or early adopters provide an effective way to create either positive or negative communication channels to drive decisions. Pharmacists communicated that having an immunization-trained pharmacy technician as part of the workflow was positive.

**Theme 5.** *Pharmacists as observers were initially hesitant, then accepting of the added member to the immunization team.*

