Designing for health equity: A mixed method study exploring community experiences and perceptions of pharmacists' role in minor ailment care.

BACKGROUND: Minor ailments are self-limiting, easily diagnosable and treatable conditions. Funded pharmacist minor ailments services (PMAS) have been posited to improve medicines access equity and, despite ethnic minorities across the globe experiencing reduced access to medicines and health care, PMAS internationally have not explicitly centered ethnic equity in service design or outcome measurement. OBJECTIVE: To explore Maori experiences of minor ailments care and perceptions of the pharmacists' role. METHODS: This mixed methods study collected data through facilitated wananga (collaborative knowledge-sharing group discussions). Eligible participants (Maori, 18 years plus, obtained medicine from pharmacy in last 3 years) were recruited through local pharmacist networks using convenience sampling. Wananga included qualitative data collection through discussion using a topic guide and a quantitative questionnaire. Indigenous theory was applied within a general inductive approach to thematic development to analyze qualitative data. Quantitative data was reported using simple descriptive statistics. RESULTS: Thirteen wananga (3 in-person, 10 online) were conducted from September 2021-February 2022 with 62 participants from seven New Zealand regions. The minor ailments that participants were most likely to seek treatment from pharmacy first, instead of a doctor, were eczema (87.2%), coughs and colds (85.7%), headlice (85.7%), insect bites (83.9%), and hayfever (83.9%). Four themes were generated from the qualitative data: designing the right environment for minor ailment care; clinically and culturally safe care; moving from stigmatizing to strengths-based services; the benefits of PMAS. Participant-informed ideas for PMAS service development centered on Maori aspirations included: developing clinically and culturally safe pharmacy environments, enabling medicine supply outside of the physical pharmacy setting, avoiding stigmatizing language when promoting PMAS availability, and collaborative practice with other health providers. CONCLUSION: This study provides important recommendations when developing PMAS to increase the likelihood of delivering equitable care, and has international application across multiple pharmacy and health service settings.

Maori, pharmacists, and medicines adherence - A mixed methods study exploring indigenous experiences of taking medicines 'as prescribed' and mechanisms of support.

Background: Medicines are the most common medical intervention and medicines adherence is associated with improved clinical outcomes. Understanding drivers and experiences of medicines adherence is important for optimising medicines use. Maori (Indigenous people of Aotearoa New Zealand) experience inequities in access to medicines yet little evidence exists regarding Maori and medicines adherence, or the role of pharmacists in supporting medicines adherence for Maori. Objectives: To explore Maori experiences of medicines adherence and non-adherence, and pharmacists' role in supporting adherence. Methods: This was a convergent parallel mixed methods study. Facilitated wananga (collaborative knowledge-sharing group discussions) were undertaken either online or in-person with eligible participants, using convenience and snowball sampling to recruit. Participants were eligible if they were Maori, 18 years or older, and had recently obtained medicine from a pharmacy. Wananga involved semi-structured interviewing and questionnaire completion. General inductive coding and thematic analysis and descriptive statistical analysis were used respectively, and findings were situated in social, cultural and political Maori contexts. Results: Thirteen wananga were conducted with 62 participants (71% female, median age range 35-44) from September 2021 to February 2022. Four themes were identified: The aspirations of hauora Maori (Maori wellbeing) - medicines as a component of holistic wellbeing; whanaungatanga (relationships); knowledge; and whanau (family and support network) advocacy and problem solving. Forgetting to take medicines was the most frequently identified reason for non-adherence, followed by not having medicines on hand, adverse effects, and lack of symptoms of health conditions. Participants identified that proactive pharmacist support, including developing caring therapeutic relationships, sharing knowledge, acknowledging medicines as just one component of holistic wellbeing, and giving adherence tips to support routine medicine taking were positive ways that pharmacists could support medicines adherence. Conclusions: Factors contributing to medicines adherence were diverse and participants identified numerous practical solutions that pharmacists, health service providers and policymakers could employ to support Maori medicines adherence.

Indigenous and immigrant populations' use and experience of community pharmacies in New Zealand.

We sought to identify what services indigenous (Maori) and immigrant populations use pharmacies for, and how long pharmacy staff spend interacting with them, as longer interactions are associated with better quality care. We review literature on counseling in pharmacy, and interaction length as an indicator of counseling quality. 1,086 interactions were discretely observed in 36 pharmacies in 5 cities around New Zealand. Maori or Pacific people, along with men, were more likely to treat pharmacies as prescription 'depots', being less likely to buy over-the-counter or pharmacist only medicines (ORs: 0.25-0.72). However, the influence of demographic factors on interaction length was small (|B|s < 7.7 s). The weak effect of ethnicity on interaction length suggests that pharmacies are providing advice of relatively consistent quality to different population groups. Possible barriers to use of pharmacies for primary healthcare, including over-the-counter medicines in Maori and Pacific people are discussed.