Exploring experiences and perspectives of inclusivity amongst community pharmacists in their practice: a survey study
Authors: Kamdar D , Hossein Y , Al-Alewi T , Abdulrahim N , Kayyali R 
Published: April 2024

Abstract

Introduction
Inclusive healthcare is an essential component of promoting sustainable good health and wellbeing. The General Pharmaceutical Council (GPhC) published their equality, diversity, and inclusivity (EDI) strategy 2021-2026 to tackle discrimination and reduce health inequalities;[1] however, there are still significant disparities in healthcare access and outcomes faced by minority groups. Discrimination leads to higher rates of distrust, non-adherence, and poorer physical and mental health outcomes.[2] Community pharmacists can break down barriers to healthcare, but must feel a sense of inclusion themselves.

Aim
To explore the experiences and perspectives of inclusivity amongst community pharmacists in their practice, including training, and to investigate inclusivity-related interventions available in pharmacies.

Methods
Following a pilot study with 14 pharmacists, an online survey using Google Forms was distributed via email to 335 community pharmacists (based on Raosoft calculator at 95% confidence interval) in multiple London boroughs within a two-month period. To maximise response rates, paper surveys were distributed in person to pharmacies. The survey comprised 48 mixed-style questions, and was divided into four sections: experiences of inclusivity and discrimination, inclusive services provided in the pharmacy, pharmacist training, and demographics. The data were analysed using descriptive and inferential statistics, using Microsoft Excel and SPSS.

Results
The response rate was 55% (n=184/335). 72% were &lt;40 years old. 55% were men, 43% women and 2% identified as ‘Other’. 59% pharmacists were Asian, 7% Black (of any origin), 4% White and 32% ‘Other’ (including mixed heritage). 68% worked in independent pharmacies (&lt;4 branches), 27% in small chains and 25% in large chains (&gt;10 branches).
18% (n=33) self-reported they had experienced discrimination, primarily from patients (88%; n=29/33), with the majority experiencing racial discrimination (79%; n=26/33), followed by 30% (n=10/33) against age. A higher proportion (24%; n=44) experienced microaggressions and 25% (n=47) reported witnessing discrimination against a patient or colleague, with 98% (n=46/47) witnessing racial discrimination. Pharmacists who had experienced microaggression were statistically less likely to feel included in the workplace. Despite this, 86% (n=159) felt their services were inclusive. However, low levels of pharmacies offered sign language interpreters (3%; n=5), pictograms (11%; n=21), pronoun badges (13%; n=23) and hearing loop systems (19%, n=35), the latter of which large chain pharmacies were statistically more likely to provide.
43% (n=79) have completed some EDI training, but under a quarter of pharmacists undertook focused training, for example, identifying skin conditions on different skin tones (22%; n=17), or making services inclusive to the LGBTQ+ community (8%, n=6).

Conclusion
Although limited with a relatively small sample size, and limited but diverse geographical area, the findings suggest discrimination continues to persist in community pharmacy, especially related to race.[2] Accessible and culturally responsive resources such as discrimination reporting mechanisms are necessary. Although most pharmacists felt their services were inclusive, the findings demonstrate this was lacking in most pharmacies, with issues surrounding funding and structural barriers. Pharmacists must raise their awareness of simple, effective measures such as free pronoun badges but also require specific EDI training to fulfil their potential as inclusive practitioners.

References
1. General Pharmaceutical Council. Delivering equality, improving diversity and fostering inclusion: our strategy for change 2021-2026. 2021. Available from: https://www.pharmacyregulation.org/sites/default/files/document/gphc-equality-diversity-inclusion-strategy-november-2021.pdf
2. Hackett RA, Ronaldson A, Bhui K, Steptoe A, Jackson SE. Racial discrimination and health: a prospective study of ethnic minorities in the United Kingdom. BMC Public Health. 2020; 20(1):1652.