Inclusive practice: a study exploring community pharmacists' perspectives, knowledge, and training of Neurodiversity (ND) and the effects on their practice
Authors: Kamdar D , Sabir R 
Published: November 2024

Abstract

Introduction
An estimated 1 in 7 people in the UK are neurodivergent, a term encompassing conditions such as autism, attention deficit hyperactivity disorder (ADHD), and other learning differences.1 Neurodivergent individuals have poorer health outcomes, increased risk of premature mortality and reduced access to healthcare.2 The Oliver McGowan case highlighted the need for raising awareness of neurodiversity and mandatory training.2 CPs are uniquely positioned to implement simple adjustments, e.g., adapting communication methods and inclusive pharmacy spaces, consequently reducing health inequalities. CPs’ knowledge, cultural perspectives and current accommodations in their practice for neurodiverse patients must be determined.

Aim
To explore community pharmacists' perspectives, knowledge and training of neurodiversity and the effects on their practice.

Methods
A mixed-methods approach was used following ethical approval from Kingston University Ethics Committee. After a pilot study, using random sampling, paper questionnaires comprising 26 mixed-style questions were distributed and collected in person to community pharmacists in East London boroughs within a two-month period. Survey participants were invited for an optional in-person or remote semi-structured interview, conducted using a validated interview guide. The minimum sample size was 129 pharmacists (Raosoft online calculator; 95% confidence interval). Data was analysed using descriptive and inferential statistics, using Microsoft Excel alongside thematic analysis for interview responses.

Results
Response rate was 80% (n=103/129) and 6 pharmacists participated in interviews. 53% (n=55) were Asian, 21% (n=22) Black, and 19% (n=20) White ethnicity. 52% (n=54) identified as male and 47% (n=48) as female.
There was a statistically significant correlation between ethnicity and perception of neurodiversity, with conditions taken less seriously in Asian and Black cultures compared to White culture (p&lt;0.001). White participants were statistically more likely to rate their knowledge as good or above in comparison to Asian or Black participants (p=0.01), with 70% (n=14/20) White participants rating their knowledge as good in comparison to 18% (n=4/22) Black and 29% (n=16/55) Asian participants. 100% (n=103/103) and 94% (n=97/103) participants were able to identify autism and ADHD respectively as neurodiverse conditions but only 20% (n=21/103) and 21% (n=22/103) respectively identified dyspraxia and dyscalculia. 94% (n=97/103) stated no changes were made to accommodate neurodiverse patients with only 3% (n=3/103) offering large-print labels or poster formats and 2% (n=2/103) offering quiet areas.
Thematic analysis demonstrated the absence of interventions and awareness was commonly due to systemic barriers and lack of specific training. Participants described diverse cultural attitudes and attached stigma to neurodiversity.

Discussion/Conclusion
There are significant gaps in knowledge about neurodiversity, possibly linked to a lack of formal training opportunities for CPs. Consequently, minimal adjustments are made to accommodate neurodiverse patients. Changes to pharmacy education and training are needed to develop general understanding, with tools that can be incorporated in pharmacies to aid neurodiverse patients and improve health literacy.2 Simple measures such as ‘quiet hours’ or large-text labels can greatly impact a person’s healthcare experience. However, improvements are required in infrastructure and resources within pharmacies, as well as shifts in cultural attitudes to encourage patients to share their status.3 Study limitations included time constraints and a small but diverse geographical area.

References
1. The Donaldson Trust. Neurodiversity [Internet]. West Lothian: The Donaldson Trust; 2023 Dec [cited 2024 May 14]. Available from: https://www.donaldsons.org.uk/neurodiversity/
2. Adams D., Tharian R. Autism: identification, management and support, The PJ [Internet]. 2023 Mar [cited 2024 May 10]; 310(7971). Available from: https://pharmaceutical-journal.com/article/ld/autism-identification-management-and-support
3. Slade G. Diverse perspectives: the challenges for families affected by autism from Black, Asian and minority ethnic communities. London: The National Autistic Society; 2014. 24 p. Available from: https://s3.chorus-mk.thirdlight.com/file/1573224908/63849355948/width=-1/height=-1/format=-1/fit=scale/t=445333/e=never/k=7c17beeb/Diverse-perspectives-report.pdf