By: Aashta Vaidhya
Every patient comes with different healthcare beliefs, values, and approaches to healthcare. This is shaped by the social determinants of health, namely race, ethnicity, gender, age, and more; and ultimately influences a patient’s health behaviors and trust in the provider.¹ Understanding the needs of underserved patients and the supportive resources available within the population can help healthcare providers cultivate culturally competent healthcare experiences for patients.¹ Cultural competency can be defined as “the attitudes, knowledge, skills, and values that an individual has and uses in working effectively in a cross-cultural environment.”¹ This is especially necessary in pharmaceutical care in which this model of care can result in benefits like successful patient education, increase in health-seeking behaviors and patient adherence, and avoidance of drug complications.¹ With changes in Canada’s demographics, and a rising need to address health disparities and patient safety in the context of culture and language, the case to shift practice to encompass the qualities of compassion, empathy, and responsiveness is necessary.¹ Health disparities is a term for preventable differences in health in those experiencing social, economic, or environmental disadvantages.¹ In Canada, Indigenous people, sexual/racial minorities, immigrants, and those with low socioeconomic status are especially affected.²
Diabetes is just one disparity that pharmacists can have an impact in minimizing. For example, a provider understanding the importance of community support for a Latino patient may recruit a promotora de salud (health promoter) for diabetes self-management education.¹ As such, pharmacists should engage the community and its resources to improve the quality and appropriateness of education materials and services.⁴ To further their ability to view culture as a powerful tool in counseling, a pharmacist should be knowledgeable in alternative medications common to certain cultures. In this manner, pharmacists can avoid drug complications due to unwanted interactions and tailor counseling sessions to a patient’s healthcare beliefs.¹ Furthermore, bridging physical and spiritual patient healing is important for those who value a holistic pathway for health.⁵ Consequently, the message is likely to be better received; allowing for improved adherence and health outcomes.¹ In addition, pharmacists must be able to accommodate for religious holiday observances or dietary restrictions with medicine in order to educate patients on modifying treatment for a tailored therapy plan.⁵ For example, Muslims observing Ramadan may not be able to sustain dietary requirements for medication or take particular thyroid medications with pork substances.⁵ Furthermore, being aware of injustices in the healthcare systems—such as the Tuskegee syphilis study on African Americans—can help pharmacists be cognizant of patient suspicion and focus on building a trusting relationship.⁵ Furthermore, a failure to provide explanation in a patient’s language can lead to medication non adherence or dosing problems, reducing efficacy or even leading to toxicity.⁶ This highlights a need for language interpreter services or web-based translators to increase the amount of information that patients receive.
It is important to recognize how an individual patient experiences and makes sense of their health may be very different from the Western culture of biomedicine—the use of procedures, drugs, and surgery to eliminate disease.⁷ As a first step, these cultural differences can be evaluated by a clinician to help guide the discovery of a patient-led approach to their care. Thus, these sessions may benefit from Kleinman’s explanatory model to emphasize the patient experience with their illness.⁵
Pharmacists are patient advocates responsible for modifying the patients understanding and adherence to the medication use process. Learning about different styles of communication and needs of culturally diverse patients is necessary for quality care that acknowledges a patient’s context. By exercising cultural competency, pharmacists can assure patients are able to manage their care plans in a manner that aligns with their cultural beliefs, customs, and lifestyle.
References:
Cultivating Cultural Competency in Pharmacy Practice. Power-pak.com. Published 2019. Accessed February 1, 2023. https://power-pak.com/course/print/120983
Government of Canada. Key Health Inequalities in Canada: A National Portrait – Executive Summary - Canada.ca. Published 2018. Accessed February 1, 2023. https://www.canada.ca/en/public-health/services/publications/science-research-data/key-health-inequalities-canada-national-portrait-executive-summary.html
Government of Canada. Infographic: Inequalities in diabetes in Canada - Canada.ca. Published 2019. Accessed February 1, 2023. https://www.canada.ca/en/public-health/services/publications/science-research-data/inequalities-diabetes-infographic.html
Bazaldua OV, Sias J. Cultural Competence: A Pharmacy Perspective. Journal of Pharmacy Practice. 2004;17(3):160-166. doi:10.1177/0897190004264812
Corsi MP, Jackson JD, McCarthy BC. Cultural Competence Considerations for Health-System Pharmacists. Hospital Pharmacy. 2018;54(6):385-388. doi:10.1177/0018578718809259
Moreno G, Tarn DM, Morales LS. Impact of Interpreters on the Receipt of New Prescription Medication Information Among Spanish-Speaking Latinos. Medical Care. 2009;47(12):1201-1208. doi:10.1097/mlr.0b013e3181adcc1b
Mary Beth O'Connell, Korner EJ, Rickles NM, Sias JJ. Cultural Competence in Health Care and Its Implications for Pharmacy Part 1. Overview of Key Concepts in Multicultural Health Care. Pharmacotherapy. 2007;27(7):1062-1079. doi:10.1592/phco.27.7.1062
Table 1 . Kleinman’s questions and the emerging themes. ResearchGate. Published 2017. Accessed February 1, 2023. https://www.researchgate.net/figure/Kleinmans-questions-and-the-emerging-themes_tbl1_317576891