Background: There is an increased need for a healthcare workforce that is culturally competent, to improve health outcomes and reduce health disparities for patients from diverse cultural backgrounds. This is important in the context of pharmaceutical care for patients, as the inability to recognise a patient’s health beliefs, which could be influenced by their cultural background, can lead to reduced medication adherence and poor treatment outcomes. This systematic review aims to explore cultural competence teaching and training in pre-qualification pharmacy education. Methods: Medline, Scopus, PsychInfo, Web of Knowledge, CINAHL, and Embase databases were systematically searched for studies that explored cultural competence in pharmacy education and were published in English from January 2012 to December 2021. Methodological quality of studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Data from included studies were thematically analysed. Results: Overall, 47 papers (46 studies) were included in the review. Of these, 40 papers focused on interventions for teaching cultural competence to pharmacy students only, the remaining studies included students from pharmacy and other health discipline programmes. Half of the studies focused on cultural competence in general (n = 20, 50%), while the remaining studies focused on competence on specific aspects e.g., cultures, religions and disabilities. Most studies (n = 24, 60%) report implementation of interventions that took place over a week. Twenty-one studies reported that cultural competence interventions were compulsory. There were variations in how cultural competence is conceptualised in studies; some studies focused on the need to increase knowledge about different cultures or ‘knowing how’; other studies focused on behavioural aspects that would help students while they work with patients from diverse backgrounds, or ‘showing how’; some studies described cultural competence as a continuum that includes both ‘doing’ knowledge and behavioural aspects. Conclusion: There is variation in how cultural competence is taught in pharmacy education programmes, which could be a consequence of differences in how authors conceptualised cultural competence. Further research is needed to develop a unified understanding of the meaning of cultural competence and how it should be taught to pharmacy students.
Purpose: The dual-task paradigm has been frequently used to examine stroke-related deficits because it samples behavioral performance under conditions of distraction similar to functioning in real-life environments. This original systematic review synthesizes studies that examined dual-task effects involving spoken language production in adults affected by stroke, including transient ischemic attack (TIA) and poststroke aphasia. Method: Five databases were searched (inception to March 2022) for eligible peer-reviewed articles. The 21 included studies reported a total of 561 stroke participants. Thirteen studies focused on single word production, for example, word fluency, and eight on discourse production, for example, storytelling. Most studies included participants who had suffered a major stroke. Six studies focused on aphasia, whereas no study focused on TIA. A meta-analysis was not appropriate because of the heterogeneity of outcome measures. Results: Some single word production studies found dual-task language effects whereas others did not. This finding was compounded by the lack of appropriate control participants. Most single word and discourse studies utilized motoric tasks in the dual-task condition. Our certainty (or confidence) assessment was based on a methodological appraisal of each study and information about reliability/fidelity. As 10 of the 21 studies included appropriate control groups and limited reliability/fidelity information, the certainty of the findings may be described as weak. Conclusions: Language-specific dual-task costs were identified in single word studies, especially those that focused on aphasia as well as half of the nonaphasia studies. Unlike single word studies, nearly all studies of discourse showed dual-task decrements on at least some variables. Supplemental Material: https://doi.org/10.23641/asha.23605311
Introduction There is an increased need for a healthcare workforce that is culturally competent to improve health outcomes and reduce health disparities for patients from diverse cultural backgrounds. This is important in the context of pharmaceutical care for patients, as the inability to recognise a patient’s health beliefs, which could be influenced by their cultural background, can lead to reduced medication adherence and poor treatment outcomes (1, 2). This review is registered with PROSPERO (Reference number CRD42021295875). Aim This systematic review aims to explore cultural competence teaching and training in pre-qualification pharmacy education. Methods This study is reported using the PRISMA Checklist. Medline, Scopus, PsychInfo, Web of Knowledge, CINAHL, and Embase databases were systematically searched for studies that explored cultural competence in pharmacy education and were published in English from January 2012 to December 2021. Methodological quality of studies were assessed using the Mixed Methods Appraisal Tool (MMAT). Data from included studies were thematically analysed. Results Overall, 47 papers (46 studies) were included in the review. Of these, 40 papers focused on interventions for teaching cultural competence to pharmacy students only, the remaining studies included students from pharmacy and other health discipline programmes. Half of the studies focused on cultural competence in general (n = 20, 50%), while the remaining studies focused on competence on specific aspects e.g. cultures, religions and disabilities. Most studies (n = 24, 60%) report implementation of interventions that took place over a week. Twenty-one studies reported that cultural competence interventions were compulsory. There were variations in how cultural competence is conceptualised in studies; some studies focused on the need to increase knowledge about different cultures or ‘knowing how’; other studies focused on behavioural aspects that would help students while they work with patients from diverse backgrounds, or ‘showing how’; some studies described cultural competence as a continuum that includes both ‘doing’ knowledge and behavioural aspects. Conclusion There is variation in how cultural competence is taught in pharmacy education programmes, which could be a consequence of differences in how authors conceptualised cultural competence. It is also challenging to know whether or not current interventions improve ‘cultural competency’ due a range of outcome measures used in the studies. Therefore, it is important to develop a set of key principles that underpin the understanding and operationalisation of the concept of cultural competence into the pre-qualification pharmacy curricula – this forms our future work. A limitation of the study was the inclusion of only papers written in English, which may therefore have inadvertently excluded relevant papers published in other languages. Additionally, grey literature was not included, which often is a key step in the dissemination of pedagogical research and scholarship. References 1. O'Connell MB, 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):1062-79. 2. Henderson S, Horne M, Hills R, Kendall E. Cultural competence in healthcare in the community: A concept analysis. Health Soc Care Community. 2018;26(4):590-603.
Introduction Despite their efficacy in reducing stroke risk in patients with atrial fibrillation (AF), oral anticoagulants (OACs) remain under-prescribed [1]. Until recently, warfarin has been the dominant OAC. The introduction of direct oral anticoagulants (DOACs) led to changes in anticoagulant prescribing patterns, with an increase in OAC prescribing and a shift towards DOACs [2]. Treatment decisions for OACs are complicated, and require a discussion between clinicians and patients when deciding on a treatment [1]. Aim To investigate the main factors that influence initial and ongoing OAC prescribing decisions for patients with AF according to patient and health professional views. Methods A systematic review was conducted according to the Toolkit for Mixed-Methods Reviews, and was registered on PROSPERO: CRD42019145406. Medline, CINAHL, Scopus, EMBASE, Web of Knowledge and PsychInfo were searched in August, 2019. Primary qualitative and quantitative studies, published between 2009 and 2019, exploring patient and health professional perceptions, views and experiences of OACs in AF were included. McMaster critical appraisal tool for quantitative studies and Critical Appraisal Skills Programme (CASP) checklist for qualitative studies were used for quality assessment. The review followed a convergent integrated approach to data extraction and analysis, which involves extracting and analysing results of quantitative and qualitative studies at the same time using the same method. A data extraction form was adapted from Joanna-Briggs Institute (JBI) mixed-methods extraction form. Study author interpretation of quantitative data was summarised as qualitative statements which were coded together with primary qualitative data using NVIVO 12 software; codes were applied to each sentence in the findings, and were grouped into a hierarchical tree structure Results The systematic review included 62 papers (58 studies) discussing clinical and non-clinical factors influencing decisions to initiate OACs, the choice between warfarin and DOACs, and the choice between individual OACs. The balance of stroke and bleeding risks was the most influential when making the decision to initiate anticoagulation according to both patients and health professionals. Convenience-related factors, such as monitoring requirements, dosing regimens, and interactions impacted the choice between warfarin and DOACs, whereas, reversibility and dosing regimen influenced the choice between individual medications according to the views of both groups. Health professional specialty and years of experience affected all aspects of treatments, with specialists and senior clinicians more willing to initiate anticoagulation and choose DOACs. Even though health professionals often expressed that patient views were considered when deciding on a treatment, patients generally said that they followed their physician’s recommendations without questioning. Conclusion The review revealed similarities and differences across patient and professional views, experiences, and preferences of anticoagulation. The main discrepancies were related to the decision-making process, and whether patient views are being considered when prescribing. Combining quantitative and qualitative evidence helped explore a wide range of views of OAC and AF, however the review only included published research papers in English, which might have led to exclusion of valuable evidence. More research is needed to explore the factors driving the choice between OACs, especially the choice between individual DOACs. References 1. Noseworthy PA, Brito JP, Kunneman M, Hargraves IG, Zeballos-Palacios C, Montori VM, Ting HH. Shared decision-making in atrial fibrillation: navigating complex issues in partnership with the patient. Journal of Interventional Cardiac Electrophysiology. 2019;56(2):159–163. 2. Loo, S.Y., Dell'Aniello, S., Huiart, L. and Renoux, C. Trends in the prescription of novel oral anticoagulants in UK primary care. British Journal of Clinical Pharmacology. 2017; 83(9): 2096–2106.
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