Tackling Inequalities in Access to Medicines for People Experiencing Homelessness: A Meta‐Ethnography and Qualitative Systematic Review

IntroductionDespite increased awareness of the detrimental relationship between homelessness and health, people experiencing homelessness remain an underserved population in health and social care research. Due to barriers affecting the accessibility of medicine and healthcare services, as well as reported competing priorities such as food and shelter, evidence has demonstrated that people experiencing homelessness are less likely to undergo routine examinations, receive diagnoses and adhere to prescribed medical treatments. To enhance service design and access for those experiencing homelessness, it is critical to better recognise, understand and address the barriers these individuals face. This meta-ethnography aims to identify barriers, enablers and interventions to begin addressing this inequality gap.MethodsA systematic literature search was undertaken in October and re-ran in December 2023 across four databases: MEDLINE, Embase, CINAHL and Scopus. Qualitative studies were included if they addressed barriers, enablers and interventions aimed at tackling medicines and health service inequalities among populations experiencing homelessness. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklist. Data were synthesised using a meta-ethnographic approach, as outlined by Noblit and Hare. The review was registered on PROSPERO (CRD42024511502) and performed according to PRISMA guidelines.ResultsThis meta-ethnographic systematic review synthesised data from eight studies across multiple countries. Three overarching third-order constructs (termed ‘themes’) were developed through reciprocal translation and centred around: recognising and acknowledging the discrimination, stigma and barriers experienced when using current services; exploring safe and practical use of medicines and the promotion of general health education and appreciating strategies to tackle inequalities, namely community outreach programmes designed for homeless communities.ConclusionThis work highlighted the barriers, enablers and interventions that sought to address the inequalities affecting people experiencing homelessness in accessing medication and healthcare services. Future research should utilise lived-experience narratives and co-design to further explore ways to tackle wider healthcare accessibility inequalities for this minoritised population.Patient or Public ContributionPublic contributors (minority research champions and one public health research champion, H.K.G. and T.G.) informed and shaped this project during study design and conceptualisation. They helped to ensure that the study was conducted, and the findings were reported with sensitivity

Implementing and Delivering Culturally Centred Pharmacy Services Tailored to Ethnically Minoritised Populations: A Qualitative Systematic Review and Meta-Ethnography

IntroductionHealth inequities disproportionately affect people from ethnic minority communities and require a comprehensive effort across healthcare disciplines to tackle them. Ethnically minoritised populations continue to be underserved, despite the growing awareness of the detrimental link between ethnicity and poorer health- and medication-outcomes. Pharmacy has been recognised as an accessible and inclusive healthcare setting, with the ability to meet diverse patient needs. Yet, there still remain distinct gaps in knowledge of how to best design, implement and deliver culturally centred pharmacy services for members of ethnic minority communities.MethodsA systematic literature search was undertaken in November 2023, across four databases: MEDLINE, Embase, CINAHL and PsycINFO. Qualitative studies were included if they addressed barriers, enablers and interventions aimed at tackling medicines- and health service inequalities affecting people from ethnic minority communities. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklist. Data were synthesised using a meta-ethnographic approach, according to Noblit and Hare, forming a qualitative evidence synthesis to further understanding.ResultsThis meta-ethnographic systematic review synthesised data from 13 international studies eligible for inclusion. Four overarching third-order constructs (termed ‘themes’) were developed through reciprocal translation and focused on: (i) navigating pharmacy systems across the globe; (ii) understanding cultural needs and beliefs that may influence medicine use; (iii) strengthening relationships with pharmacists and other healthcare providers and (iv) addressing possible language and communication barriers.ConclusionPharmacists and policymakers should aim to raise awareness of pharmacy services, increase the provision of cultural competency training within the profession, build stronger relationships with minority communities, and facilitate access to interpretation services. A template of recommendations has been developed to further implement and deliver such services on an individual pharmacy-, community- and profession-basis. Future research should seek to utilise lived-experience narratives and participatory co-design methods to further explore ways to address wider healthcare accessibility inequalities for this minoritised population.Patient or Public ContributionPublic contributors and authors (inequity research champions, G.K. and T.G.) informed and shaped this project during study design and conceptualisation; they helped to ensure that the study was conducted, and the findings were reported, with sensitivity

Embedding cultural competency and cultural humility in undergraduate pharmacist initial education and training: a qualitative exploration of pharmacy student perspectives

BackgroundEmphasis has been placed upon embedding equity, diversity and inclusion within the initial education and training of healthcare professionals, like pharmacists. Yet, there remains limited understanding of how best to integrate cultural competency and cultural humility into undergraduate pharmacy student training.AimThis qualitative study explored the views of pharmacy students to understand perspectives on, and identify recommendations for, embedding cultural competency and cultural humility within pharmacy education and training.MethodUndergraduate pharmacy students from one UK-based School of Pharmacy were invited to participate in an in-person, semi-structured interview to discuss cultural competency in the pharmacy curriculum. Interviews were conducted between November 2022 and February 2023 and were audio-recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes. QSR NVivo (Version 12) facilitated data management. Ethical approval was obtained from the Newcastle University Ethics Committee.ResultsTwelve undergraduate pharmacist students, across all years of undergraduate training, were interviewed. Three themes were developed from the data, centring on: (1) recognising and reflecting on cultural competency and cultural humility; (2) gaining exposure and growing in confidence; and (3) thinking forward as a culturally competent pharmacist of the future.ConclusionThese findings offer actionable recommendations to align with the updated Initial Education and Training standards from the United Kingdom (UK) pharmacy regulator, the General Pharmaceutical Council; specifically, how and when cultural competency teaching should be embedded within the undergraduate pharmacy curriculum. Future research should further explore teaching content, learning environments, and methods of assessing cultural competency

Understanding polypharmacy for people receiving home care services: a scoping review of the evidence

Background: Polypharmacy, defined as the concurrent use of five or more medications, is common amongst older adults receiving home care services. The relationship between home care and polypharmacy may be critical to older people’s health, but there is little research on this topic. Objective: To understand the extent and type of evidence on individuals receiving home care services and experiencing polypharmacy. Methods: This review followed the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Three databases (MEDLINE, Embase, CINAHL) were systematically searched (December 2023) to identify studies with adult participants experiencing polypharmacy and receiving home care. Results: Twenty-three studies were included. For individuals receiving home care services, the studies reported on the following: (i) prevalence of polypharmacy, (ii) interventions to reduce inappropriate polypharmacy, (iii) perceived role of home care workers, (iv) assessment of health literacy in individuals experiencing polypharmacy, and (v) factors associated with polypharmacy and potentially inappropriate medications (PIMs). Polypharmacy and PIMs were found to be associated with older age, female sex, increased frailty, living alone, poor economic situation and inaccuracies within medical records. Improved appropriateness of prescribing can be achieved through interprofessional interventions, efficient use of home care workers and improved health literacy. Conclusion: This review highlights research on the extent of polypharmacy in home care and ways to address it. Whilst there are suggestions for enhancing medication quality, key gaps remain in research into the experiences of care staff and recipients in managing medications and polypharmacy, which should be addressed

Accessing Care Across Cultures: Qualitative Insights Into the Reality of Informal Caregivers From Ethnically Minoritised Groups

IntroductionThere remains limited research exploring the experiences of informal carers from ethnically minoritised groups, particularly to illustrate perceptions of caring roles and challenges they may face to address unmet needs. While barriers such as language, cultural expectations and discrimination are acknowledged in wider literature, little is known about how these influence caregiving experiences or access to services in practice. This work seeks to better describe the barriers and facilitators impacting carers from ethnically minoritised groups, as well as illustrate possible influences of culture and carer identity affecting this under-researched population.MethodsThroughout June–July 2024, semi-structured interviews were conducted with informal caregivers from ethnically minoritised groups (including: Pakistani, Black African, Indian, Arab, Chinese and Yemeni communities). Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis was used to develop themes. Ethical approval was obtained from Newcastle University Research Ethics Committee, ref: 2275/46476).ResultsFourteen carers of a variety of ages and ethnicities participated. Three overarching themes were developed from the data that centred on the following:Defining the role of a carer: people\u27s journeys to becoming carers and links to roles as interpreters.Advocating for inclusive care: to receive accessible and understandable information.The impact of a person\u27s wider community and culture upon their caring responsibility: culture and health are interlinked, and this influences the support that carers may need.ConclusionCarers from ethnically minoritised groups have faced challenges with linguistic barriers and the paucity of healthcare services that are sensitive to cultural differences. Much of the work to date has focused on ‘formal’ caregivers and paid roles, as well as the experiences of people from ethnic majority groups. This study contributes unique perspectives to the current knowledge base and raises novel, learning points specific to supporting carers from ethnically minoritised groups. Future research could extend the conclusions from this work to specifically explore possible ethnic and cultural nuances in caring experiences.Patient or Public ContributionAn informal carer (David Black) was involved in the design of the study and its materials, and carers from various ethnic minority groups were involved. The NIHR INVOLVE guidelines and recommendations for carer involvement in research were followed