Development and feasibility testing of a training programme for community pharmacists to deliver a culturally responsive medication review intervention

Abstract

Background Cultural differences between health professionals and Indigenous peoples contribute to health inequalities, and effective cross-cultural communication and person-centred healthcare are critical remedial elements. Community pharmacists can play a significant role by reducing medication-related problems through medication reviews, yet barriers to access include cultural and linguistic challenges. The Indigenous Medication Review Service (IMeRSe) aimed to address these barriers via a culturally responsive intervention. The aim of this paper is to present the cross-cultural training framework developed as a component of this intervention and the feasibility evaluation of the first stage of the training framework. Methods A training framework was developed, emphasising pharmacists’ skills and confidence in effective cross-cultural communication and relationship-building with Indigenous Australians (Please note that the use of the term ‘Indigenous’ in this manuscript includes all Aboriginal and Torres Strait Islander people and acknowledges their rich traditions and heterogenous cultures) across three stages: (1) online and workshop-based, covering Indigenous history and health, cross-cultural communication and a holistic, strengths-based approach to intervention delivery; (2) orientation to local Aboriginal Health Services, community and cultural protocols; and (3) ongoing mentoring. The feasibility evaluation of the first stage included the following: self-reported levels of cultural capability, cultural confidence and skills, motivators and barriers to working with Indigenous Australians, assessed pre- and post-training. Participants completed self-administered questionnaires including a 22-item validated Cultural Capability Measurement Tool. Paired t tests assessed change in mean scores of Likert scale data. Results Stage 1 development resulted in an 8.5-h standardised cross-cultural training programme tested with 39 pharmacists working across urban and rural/remote Australia. Thirty-six pharmacists completed the feasibility evaluation (75.7% female, all non-Indigenous, 75.7% never attended prior cross-cultural training). Participants reported overall acceptability with training; the majority perceived it added value to their practice. Improved cultural capability post-training was reflected in increased scores for 21/22 items, nine reaching statistical significance. There were significant improvements for all 26 confidence and skills statements, and selected motivational and barrier statements, particularly participants role in improving Indigenous health outcomes and cross-cultural communication. Conclusions This study provides preliminary evidence that the training programme was feasible to deliver and prepared pharmacists to deliver a culturally responsive medication review intervention. The online knowledge-based modules and face-to-face workshops provide a standardised framework for larger-scale implementation of the intervention training. Trial registration Australia and New Zealand Clinical Trials Registry ACTRN12618000188235.Prospectively registered 22 January 2018.

Systematic review of Indigenous cultural safety training interventions for healthcare professionals in Australia, Canada, New Zealand and the United States

“…The 13 analysed studies were published between 2014 and 2022. The majority (n=7) were conducted in Australia 40 44 46–49 52. A smaller number (n=4) took place in Canada 38 41 45 51.…”

“…Evaluation design varied widely. Nine of the studies applied mixed methods37 38 41 44–46 48 49 52 including various combinations of surveys, open-ended questions, semistructured interviews and talking circles. One of these was a randomised trial that incorporated a participatory action research approach, in which the research team cooperated with the communities, supporting institutions and participants 49.…”

“…Another two were quantitative 40 51. Eight studies incorporated preintervention/postintervention surveys 38 40 41 45 48 49 51 52. Six of the studies incorporated some measure of longer-term impact as part of the evaluation with varied follow-up periods: across 3 years44; 12 months49; 6 months39 48 and 3 months 38 41.…”

“…One intervention was described and evaluated across multiple publications as part of a larger research programme 48 49. Most (n=10) but not all of the studies, provided access to and/or a detailed description of their evaluation tools 37–41 44 48 49 51 52. Of the 11 studies that used survey tools, 8 employed previously validated evaluation tools,38 40 41 45 48 49 51 52 2 of these, although validated, were adapted by the research team 41 51…”

“…The majority (n=8) occurred in clinical settings and the remainder were either online (n=3) or a mix of online and in a classroom (n=2). Three of the studies recruited specialised practitioners: rheumatologists,38 pharmacists52 and speech language therapists 39. One study recruited only family medicine residents51 whereas another focused on nurses 45.…”