Lucille Crafford
Clinical pharmacists play a vital role in optimizing medication therapy and contributing to patient-centered care within healthcare teams. Despite their recognized value, their integration into healthcare systems remains a challenge, particularly in resource-constrained settings. In South Africa, systemic barriers, limited professional recognition, and role ambiguity affect pharmacists’ motivation, professional identity, and ability to collaborate effectively. This thesis investigates the integration of clinical pharmacists into South Africa’s healthcare system, focusing on their roles, motivation, and professional identity. The overarching research question was: How can clinical pharmacists’ roles, motivation, and professional identity formation be better understood to optimize their integration into the South African healthcare system? Chapter 1 provides an overview of the historical development of clinical pharmacy and contextualizes the South African healthcare system. While progress has been made toward formalizing clinical pharmacy practice, challenges remain regarding professional recognition, mentorship, and systemic support. The chapter introduces Self-Determination Theory (SDT) and the Boundary-Crossing Framework as theoretical lenses for examining pharmacists’ roles, motivation, and professional identity formation, and explores the systemic, relational, and personal factors influencing their integration. Chapter 2 describes a quantitative survey examining healthcare professionals’ understanding of the role and competencies of clinical pharmacists. Doctors and nurses demonstrated significantly poorer understanding of clinical pharmacists’ roles than pharmacists and clinical pharmacists, while some pharmacists were uncertain about the scope of clinical pharmacy practice. These findings highlight the need to improve role clarity, professional recognition, and interprofessional collaboration to support the integration of clinical pharmacists into healthcare teams. Chapter 3 investigates the motivation of clinical pharmacists using SDT. Clinical pharmacists demonstrated high autonomous motivation, but also high controlled motivation, while amotivation was higher among pharmacists without dedicated clinical positions or financial recognition. Qualitative findings identified autonomy and relatedness as key drivers of autonomous motivation. Creating supportive work environments through clear role definitions, interprofessional collaboration, and institutional recognition can optimize motivation and sustain engagement in clinical roles. Chapter 4 explores how clinical pharmacists perceive other healthcare professionals’ understanding of their role and how this influences their motivation and the implementation of clinical pharmacy services. Two themes emerged: Time, highlighting the importance of dedicated ward time for service implementation and work motivation, and Trust, emphasizing the influence of misconceptions, role ambiguity, and professional recognition on collaboration. These findings demonstrate how systemic, relational, and personal factors interact to influence service implementation and motivation. Chapter 5 explores how clinical pharmacists develop their professional identity while transitioning from dispensing-focused roles to patient-centered clinical practice. Three themes were identified: Bridging the gap within, Bridging the gap between, and Building bridges. Professional identity formation is shaped by intrapersonal challenges, interprofessional boundaries, and the absence of structured career pathways. Mentorship, interprofessional education, and communities of practice can support pharmacists in navigating these evolving roles. Chapter 6 synthesizes the findings, demonstrating that the integration of clinical pharmacists is shaped by the interaction of systemic, relational, and personal factors. Systemic barriers create a ripple effect that influences professional identity formation, motivation, and role integration. Boundary-crossing behaviors, such as building trust, demonstrating expertise, and engaging in patient care, support integration, but cannot replace structural and organizational support. The findings have relevance for other low- to middle-income countries where clinical pharmacy services are still evolving. This thesis provides a comprehensive understanding of the factors influencing the integration of clinical pharmacists into South Africa’s healthcare system. By applying SDT and the Boundary-Crossing Framework, it demonstrates how pharmacists navigate challenges while developing their professional identity. Addressing systemic barriers, strengthening interprofessional collaboration, and establishing structured career pathways are essential for supporting the sustainable integration of clinical pharmacists and enhancing patient care in resource-constrained settings.