An exploration of factors affecting the use of community pharmacy services by South Asians in Leicester
Understanding the philosophy of a different culture and integrating this understanding into the provision of pharmaceutical care is challenging and complex. This thesis argues the importance for community pharmacists to acknowledge that culture, religion, family and community dynamics can impact on patients’ health, health seeking behaviour and medicines adherence. The perceptions of members of the South Asian population, general practitioners, and community pharmacists about how these factors are viewed in relation to community pharmacy services were explored in this study. It was conducted in Leicester City, which has a South Asian minority ethnic population of more than 25%. Participants’ views of the role of extended community pharmacy services in the wider government agenda were explored. South Asians attitudes to healthcare, self care and the management of minor ailments were discussed. A qualitative methodology approach was adopted, which used constructivist and interpretive principles. Data collection for the study was conducted in two phases. In Phase 1, one to one semi-structured interviews were conducted separately with six local GPs and five community pharmacists from both ‘white’ (European) and South Asian backgrounds. In Phase 2, six gender specific focus groups were convened comprising of fifty five participants in total from the Sikh, Moslem and Hindu communities. Bi-lingual community workers were used in this study which allowed a more ‘sensitive’ exploration of the sociological aspects of health seeking behaviour and the impact of ‘cultural’ influences on medicines adherence. The need for ‘cultural competence’ of community pharmacists is discussed as one of the major contributions to the evidence base for pharmacy practice. Such initiatives would require pharmacists to acquire more effective consultation skills in the first instance. South Asians expressed views that community pharmacists need to be more knowledgeable, responsive and flexible in their professional practice by assessing their pharmaceutical needs and being aware of particular cultural sensitivities when planning their services in line with the new pharmaceutical contract. More specifically, South Asian participants illustrated the need for community pharmacists and their staff to be more ‘culturally knowledgeable’ about the communities in which they practice. It is argued that the provision of a more culturally sensitive and pro-active service is needed to develop a better patient-practitioner professional relationship that promotes trust. South Asians illustrated how certain behavioural, religious and cultural beliefs impact on medicines adherence, such as compliance issues whilst on holiday to their homeland, the impact of religious pilgrimage and fasts. Many South Asian participants had limited understanding about ‘generic’ medicines and considered these to be ‘inferior’ or ‘less effective’ than ‘branded’ medication. Participants’ views of ‘sharing’ of medicines and medicines waste were also illustrated. Factors such as ‘stress’, ‘fate’ and ‘karma’ and their impact on health of the participants were discussed. Many of these factors could not be solely attributable to a South Asian ‘culture’. However, the findings illustrate a need for a Medicines Use Review (MUR) service to include more ‘targeted’ exploration of medicines adherence and medicines optimisation for this population. The findings also highlighted why South Asians rarely consult the community pharmacist about sensitive or stigmatised issues such as depression, and how some conditions and symptoms were perceived to have negative impact on the ‘social acceptance’ of South Asian individuals within their own communities. South Asians suggested that community pharmacists needed to be more pro-active and ‘responsive’ to their pharmaceutical needs and respect confidentiality through use of private consultation areas for routine counselling, health promotion and medicines information. All participants endorsed a need for more ‘professional’ recognition of the pharmacist not only as an autonomous health care professional, but as one integral to providing NHS services relating to medicines and public health. The findings illustrated a lack of professional collaboration between community pharmacists and GPs, confounded by community pharmacists being ‘subordinate’ to GPs and portraying more of a ‘shopkeeper’ image. South Asians were well informed about the lack of shared medical records and relied heavily on a doctor’s definitive ‘diagnosis’ for somatic symptoms related common ailments. South Asians pro-actively engaged with ‘community action’ based approaches in health education and health promotion, and an opportunity for community pharmacists to become more involved with social initiatives was inferred from the findings. Candid and animated discussions explored their understanding of exercise as part of weight management and their interpretation of effects of the use of herbal products, alternative practitioners and the importance of collaboration with religious and community leaders in promoting medicines adherence. Participants desired alternative communication methods other than leaflets (translated or otherwise), including the use of audio-visual means and use of media. Communication difficulties were still prevalent, and trained interpreters were rarely used. By embracing some of these challenges, community pharmacists could enhance the value of their services and provide a more meaningful, ‘culturally’ competent and responsive services based on the needs of their local populations and nurture a better trusting and professional relationship with their service users and healthcare colleagues.
- PhD