A scoping review of the minority stress processes experienced by sexual and gender minority individuals in pharmacy settings: Implications for health care avoidance

Through the Lens of Societal Norms and Experiences: Students' Conceptualization of Patient Case Data When Diversity is Apparent

OBJECTIVE

There are increasing calls to improve the representation of diversity within case-based learning materials, yet it is unclear how students interpret the inclusion of diversity data when synthesizing case information. The objective of this study was to determine factors that influence students' interpretation of written case data for visualization of a patient case.

METHODS

This was a qualitative study using interviews. Entry-to-practice pharmacy students from Dalhousie University in Canada were recruited to review 6 cases, each with varying representations of diversity (eg, race, sexual orientation, gender, relationship status, disability, or none). Students were prompted to state how they visualized the case patient and what factors influenced their perceptions. Interviews were audio-recorded and transcribed verbatim. A reflexive thematic analysis was conducted to interpret themes.

RESULTS

Interviews were conducted with 18 students. Students relied on 5 factors when interpreting case data in the presence of diversity. In addition to the case data itself, these included personal experience (relating to themselves or personal relationships), professional experience (through work or school), population stereotypes, and perceived societal norms.

CONCLUSION

This study found that students rely on their personal and professional experiences, perceptions, and social conditioning when interpreting the presence of diversity within learning materials. Findings support the notion that educators should deliberately and conscientiously expose students to a broad representation of diverse populations to increase students' knowledge and understanding of populations, and to create intentional time and space to challenge existing stereotypes that contribute to the inequities in health care.

Two-Spirit Peoples' experiences accessing and receiving care from community pharmacies

Background

Two-Spirit Peoples face unique challenges in accessing and receiving health care in Canada due to health services, including community pharmacy services, being built on hetero- and cis-normative models that impede appropriate care for this group. Currently, there is limited published information on Two-Spirit Peoples' experiences accessing and receiving care in community pharmacy settings.

Methods

To address the lack of published information, 21 Two-Spirit individuals shared their experiences in a focus group setting. Four different focus groups were held across Canada, including 1 in Saskatoon, Vancouver, Edmonton, and Toronto. Informed by Indigenous methodologies, data were recorded via audio recording and notetaking, and the audio was transcribed and then analyzed for themes using the Voice-Centred Relational Method.

Results

Three major structural systems that affect the experiences of Two-Spirit Peoples in community pharmacies were identified: 1) white supremacy, 2) capitalism, and 3) heteronormativity. These 3 systemic issues presented themselves via racism, homophobia, transphobia, pharmacists' lack of knowledge about Two-Spirit individuals and their health and lack of time spent educating or building relationships with Two-Spirit Peoples. Participants provided suggestions for how community pharmacists can better serve the Two-Spirit community, such as using inclusive language, adding pronouns and preferred names to patient files, increasing knowledge about Two-Spirit health and advocating for Two-Spirit Peoples.

Discussion

The results suggest that dismantling current structures and ideologies in community pharmacy and society are required to overcome the identified issues.

Conclusion

Two-Spirit Peoples face barriers when it comes to accessing and receiving care in community pharmacies, resulting in many Two-Spirit individuals avoiding health care to save themselves from unsafe and uncomfortable interactions. Pre- and postlicensure pharmacy education about Two-Spirit Peoples is required to improve Two-Spirit Peoples' experiences accessing and receiving care in community pharmacies.

A Scoping Review of Interprofessional Education Training Aimed to Improve 2SLGBTQ+ Health

OBJECTIVES

This scoping review aims to identify and summarize the available literature on 2-spirited, lesbian, gay, bisexual, transgender, queer, plus (2SLGBTQ+) interprofessional health education and to identify optimal methods of interprofessional training to improve health care professional competency for this patient population.

METHODS

A search of PubMed and Embase was conducted and supplemented with a manual search of reference lists from identified articles. Articles were included if they reported an interprofessional education event on the topic of 2SLGBTQ+ health to at least 2 or more groups of health care professionals or students. Article screening was completed independently by 2 reviewers. Data from the included articles were extracted and mapped according to the type of participant (health care students or working health care professionals), type of event (workshop, case-based, course/curriculum, or forum), and type of assessment.

RESULTS

One hundred articles were screened, of which 15 articles met the inclusion criteria. Twelve articles focused on interprofessional health education for entry-to-practice students, with the remaining 3 articles involving practicing health care professionals. When mapped by type of event, 1-time case-based and workshop style events were the most used to deliver training. All 15 studies used an immediate presurvey and postsurvey design to evaluate the knowledge and competence of the participants after training.

CONCLUSIONS

Interprofessional education for improving 2SLGBTQ+ health is largely delivered within entry-to-practice degree programs via 1-time events with knowledge- and confidence-based assessments. Further research is needed to determine the impact of this training in practice, as well as the applicability for the training of practicing health care professionals.

Evaluation of gender-affirming care experiences of transgender and gender diverse patients within a LGBTQ+ community pharmacy

BACKGROUND

Transgender and gender diverse (TGD) populations require personalized care. Lived experiences and needs TGD populations express, compounded by limited care access, negatively shape health care involvement. Manifestations from these barriers may present as health care avoidance, identity concealment, or preventive care hinderance. Community pharmacies remain engagement points for TGD patients, but gender diverse services remain limited. What remains unknown is how TGD pharmacy perceptions and behaviors are influenced with gender-affirming care (GAC) accessibility.

OBJECTIVES

The primary objective is to assess how TGD patient perceptions and behaviors toward community pharmacy experiences are affected through a lesbian, gay, bisexual, transgender, queer/questioning, and others (LGBTQ+) community-based health system.

METHODS

A cross-sectional, multisite, reflective survey was conducted at 4 LGBTQ+ community pharmacies in central and southwest Ohio. Nine 5-point Likert-item questions and one ordinal question were used to analyze perception and behavior. Participants responded for LGBTQ+ and external pharmacy experiences respectively. Data were analyzed through descriptive methods, paired Student's t test, and Fisher's exact test or c2 test where appropriate.

RESULTS

In total, 267 surveys were completed with 96 TGD submissions qualifying for analysis. Perceptions toward pharmacy experience saw statistically significant differences among all evaluations of perception. Behavioral assessment demonstrated statistically significant improvements in pharmacy outreach except for seeking medications from outside sources. Respondents indicated more involvement with the LGBTQ+ pharmacies versus external pharmacies in discussing medications (96.9% vs. 60.4%), care plans (64.6% vs. 41.6%), disclosure of pronouns or gender (97.9% vs. 43.8%), and feeling needs were understood (96.8% vs. 51%).

CONCLUSION

Inclusive community pharmacies may positively affect pharmacy perceptions and behaviors of TGD patients. These findings call attention to barriers in the provision of care for TGD patients while highlighting the change community pharmacies can have when providing these services. Community pharmacies should be encouraged to incorporate inclusive environments to improve TGD patient care involvement and access.

Raising voices of 2SLGBTQIA+ patients: The intersection of minority stress and systemic oppression in pharmacy practice

BACKGROUND

Two-spirit, lesbian, gay, bisexual, trans, queer, intersex, asexual, and other sex, sexual, and gender identities (2SLGBTQIA+) experience minority stress processes in pharmacy settings. Processes may be distal (objective prejudicial events) or proximal (subjective internalized feelings) and lead to delay or avoidance of care. The nature of these experiences in pharmacies and ways to reduce occurrence is largely unknown.

OBJECTIVES

This study aimed to characterize 2SLGBTQIA+ individuals' perceived experiences in pharmacies according to the minority stress model (MSM) and to elicit patient-identified individual, interpersonal, and systemic strategies for reducing systemic oppression of 2SLGBTQIA+ individuals in pharmacy practice.

METHODS

This was a qualitative phenomenological study using semistructured interviews. Thirty-one 2SLGBTQIA+ individuals from the Canadian Maritime provinces completed the study. Transcripts were coded according to domains of the MSM (distal and proximal processes) and the lens of systemic oppression (LOSO) (individual, interpersonal, and systemic factors). Framework analysis was used to identify themes within each theoretical domain.

RESULTS

Distal and proximal minority stress processes were described by 2SLGBTQIA+ individuals in pharmacy settings. Distal processes included direct and indirect perceived discrimination and microaggressions. Proximal processes included expectation of rejection, concealment, and internalized self-stigma. Nine themes were identified according to the LOSO. Two related to the individual (knowledge and abilities, respect), 2 related to interpersonal relations (rapport and trust, holistic care), and 5 related to systemic factors (policies and procedures, representation and symbols, training/specialization, environment/privacy, technology).

CONCLUSION

Findings support the notion that individual, interpersonal, and systemic strategies can be implemented to reduce or prevent minority stress processes from occurring in pharmacy practice. Future studies should evaluate these strategies to better understand effective ways to improve inclusivity for 2SLGBTQIA+ people in pharmacy settings.

Target users' acceptance of a pharmacist-led prescribing service for pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV)

Background

Pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) is a highly effective way to reduce virus transmission. There have been increasing calls to improve access to PrEP in Canada. One way to improve access is by having more prescribers available. The objective of this study was to determine target users' acceptance of a PrEP-prescribing service by pharmacists in Nova Scotia.

Methods

A triangulation, mixed-methods study was conducted consisting of an online survey and qualitative interviews underpinned by the Theoretical Framework of Acceptability (TFA) constructs (affective attitude, burden, ethicality, intervention coherence, opportunity cost, perceived effectiveness and self-efficacy). Participants were those eligible for PrEP in Nova Scotia (men who have sex with men or transgender women, persons who inject drugs and HIV-negative individuals in serodiscordant relationships). Descriptive statistics and ordinal logistic regression were used to analyze survey data. Interview data were deductively coded according to each TFA construct and then inductively coded to determine themes within each construct.

Results

A total of 148 responses were captured by the survey, and 15 participants were interviewed. Participants supported pharmacists' prescribing PrEP across all TFA constructs from both survey and interview data. Identified concerns related to pharmacists' abilities to order and view lab results, pharmacists' knowledge and skills for sexual health and the potential for experiencing stigma within pharmacy settings.

Conclusion

A pharmacist-led PrEP-prescribing service is acceptable to eligible populations in Nova Scotia. The feasibility of PrEP prescribing by pharmacists should be pursued as an intervention to increase access to PrEP.

Academic Activism: An Avenue to Action

Until now, the term "advocacy" in pharmacy education and practice has focused on advocating for the advancement of the pharmacy profession or patient advocacy. With the 2022 Curricular Outcomes and Entrustable Professional Activities publication, the focus of advocacy has broadened to include advocacy for other causes that impact the health of patients. This commentary will highlight 3 pharmacy-focused organizations advocating for social issues impacting the health of patients as well as encourage members of the Academy to continue to expand personal social advocacy efforts.