Drug Information Needs of Minorities

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Drug Information Needs of Minorities

• Evelyn Schaafsma, MRPharm
• Science Shop for Medicines
• University of Groningen, NL

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Drug information needs of minorities in our
society

• How does medication literacy differ from the
  dominant population?
• How do we -as pharmacists- have to adjust our
  communication strategies?

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In this presentation

• Patient information medication literacy
• Definition of minorities
• What are specific barriers of minorities for
  access to medicines information?
• What are effective strategies?
• Oral
• Written
• Audiovisual

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For proper drug use the patient needs

• to know and understand usage instructions
• background information
• to be motivated
• the ability to perform the instructions
• Paes 1997

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Methods for patient education

• Oral communication
• motivate patient by tailor made information
• Written materials
• knowledge transfer
• Audio/visual materials
• complex instructions, e.g asthma

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Low literacy skills

• Trouble with written directions
• Trouble understanding verbal directions
• limited vocabulary skills -gt simple words
• abstract idiom -gt concrete directions
• trouble formulating questions
• Brooks 1998

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Functional Medication Literacy

• Ability to
• read
• comprehend
• act
• on medicines information like
• medication labels, package inserts, PIL
• required to perform proper drug use

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A Minority

• mostly has a low socioeconomic position
• shares a common cultural background
• is powerless, due to small numbers or weak
  position in society
• for several generations
• Veenman 1999, 2000

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Ethnic minorityDutch governmental definition

• A person or his parents
• born abroad in a
• non-western country
• Veenman 1999, 2000

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Dutch immigrants

• From former Dutch colonies
• (Indonesia, Surinam, Dutch West Indies)
• Labor immigrants
• (Moroccan, Turkish)
• Refugees

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Patients whose first language is not the same as
that of the health care system

• Ask yourself as a pharmacist
• Is my oral/written medication information
  suitable for these patients?
• How can I adjust my information?

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Access to drug information Specific barriers of
minorities

• Second language issues
• Cultural differences
• Low socio-economic conditions

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Language issues

• First generation labor immigrants
• poor Dutch language skills
• low literacy
• Refugees
• highly educated lt-gt low literate

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Cultural differences

• Sapit-Whorf hypothesis
• the world as you know is largely predetermined
  by the language of your culture
• Jandt 2001

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• Cultural differences
• ?
• Different beliefs, attitudes, norms and values
• ?
• Different perception of medication

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Translation barriers

• Vocabulary problems Do words exist in both
  languages?
• - E.g. remska virus, bacteria
• Idiomatic problems What is the meaning of a
  specific combination of words? What is natural to
  a native?
• - E.g. indirect speach

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Translation barriers-continued-

• Experiential problems Does the object or
  experience exist in both cultures?
• E.g. suppositories, preventive medicine
• Conceptual problems Do we experience the same
  meaning by a word or a concept?
• E.g. prescription medication
• Jandt 2001

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Socioeconomic status

• Low education
• knowledge of human body and causes of diseases
  limited
• ?
• background of medication treatment poorly
  understood

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Socioeconomic status

• Low socioeconomic status
• related with poorer health
• ?
• Immigrants are at risk of poorer health and may
  need more pharmaceutical care

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Strategies for effective cross-cultural
communication

• Oral communication
• Patient education material
• Written material
• Multi media material

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Oral communication

• In first language of health care system
• In first language of patient
• Accompanying relatives / acquaintances
• Bilingual pharmacist / technician
• Professional medical interpreter / advocate

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Communication strategy

• L1 health care professional
• educating patient
• - misinterpretations by patient
• Paes 1997, Verrept 1998

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Communication in first language patient
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Communication strategy
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Accompanying persons in health care

• The Netherlands
• 67 of Turkish Moroccan patients
• 82 of female T M patients
• Verrept 1998
• Austria
• 60 of hospital staff state almost always
• Pochhaker 2000

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Bilingual staff

• In the Netherlands
• Bilingual staff in pharmacies
• In Australia / Sweden
• List of languages, spoken by pharmacists.
• Counselling in person or by phone
• Personal comm.

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Interpreting / Advocacy

• Interpreting service
• National medical interpreting services by phone
  in The Netherlands hardly used in pharmacies
• Paes 97, Kroeze 96
• Advocacy
• Available in Belgium, UK, Canada, Australia.
• Use in pharmacy?
• Personal comm Verrept 1998 Goodyer et al
  -in press

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Cross-cultural, oral communication in pharmacy

• Speak slowly and clearly, do not yell
• Use simple words small sentences
• Use feedback methods
• summarize non-verbal signals
• Use visual aids
• Paes 1997, Elder-Th. 2001

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Cross-cultural, oral communication in pharmacy

• With (informal) interpreter
• Dont forget basic communication skills!
• Speak slowly and clearly
• Use simple words and small sentences
• Use feedback summaries non-verbal signals
• Use visual aids
• Talk to the patient
• Full interpretation encourages patients
• Paes 1997, Elder-Th. 2001

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Patient education materials
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Written materials in second language (L2)

• Use low reading level ? pres. 3
• Use visual aids ? pres. 4
• Paes 1997, Bell 1992

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Translated (L1) materials

• Language / cultural bias
• Expert - translator bias
• ?
• Design evaluate materials with target group,
  translator pharmacist
• Test readability before after translation
• Use back translation
• Beware of different dialects

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Multi media system

• UK
• Multi media system (touch screen) for
• inhaled asthma medication instruction
• - in English (tested versus leaflet)
• - in Turkish (tested versus leaflet / advocate)

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Multi media system -continued-

• English group
• - Animated pictures
• useful for educating inhaler techniques
• e.g. co-ordination breathing
• Turkish group
• Very poor baseline inhaler technique
• No improvements after leaflet
• Minor improvements after multi media
• Intensive counseling needed

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Other education methods

• Video
• Audio
• Call center
• ..?

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Future developments

• More research about needs of minorities and
  evaluation of educational methods
• New educational methods?

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• Interculturalisation is an enrichment of our
  health care system, if we want work towards
  tailor made care.
• Dutch Minister of Health, 2000