Understanding the experiences of Black Nova Scotians with community pharmacists.

Background: A history of medical abuse and social inequality confounded by persistent racial discrimination in health care has triggered mistrust between Black patients and health care providers. Although the consequences of systemic racism on health outcomes are well understood, little is known about how they manifest in pharmacy practice. The objective of this study was to explore the experiences of Black Nova Scotians with community pharmacists. Methods: This was a qualitative study that used focus groups and one-on-one interviews. Black Nova Scotians 18 years of age and older who have had interactions with community pharmacists were invited to participate. Focus groups and interviews were audio-recorded, transcribed and analyzed thematically. Results: Two focus groups (n = 10) and 6 one-on-one interviews were held between May and June 2021. Three major themes were identified: 1) difficulties navigating a pharmacy as a Black person, 2) lack of inclusivity and cultural competence in the pharmacy and 3) transactional relationships with pharmacists. Discussion: Most participants felt their race negatively affected the quality of care they received from the pharmacist and that pharmacists were not culturally competent. Most participants did not consider pharmacists to be part of their health care team and described feeling unsafe or uncomfortable in the pharmacy. Conclusions: Pharmacists have an important role in closing the health equity gap. This research highlights the need for pharmacy education to include cultural competence and will be used to guide strategies to improve access to culturally safe pharmacy services for Black Nova Scotians.

Intersectionality, health equity, and EDI: What's the difference for health researchers?

Many countries adopted comprehensive national initiatives to promote equity in higher education with the goal of transforming the culture of research. Major health research funders are supporting this work through calls for projects that focus on equity, resulting in a proliferation of theoretical frameworks including "intersectionality," "health equity," and variations of equity, diversity and inclusion, or EDI. This commentary is geared at individual principal investigators and health research teams who are developing research proposals and want to consider equity issues in their research, perhaps for the first time. We present histories and definitions of three commonly used frameworks: intersectionality, health equity, and EDI. In the context of health research, intersectionality is a methodology (a combination of epistemology and techniques) that can identify the relationships among individual identities and systems of oppression; however, it should also be used internally by research teams to reflect on the production of knowledge. Health equity is a societal goal that operationalizes the social determinants of health to document and address health disparities at the population level. EDI initiatives measure and track progress within organizations or teams and are best suited to inform the infrastructure and human resourcing "behind the scenes" of a project. We encourage researchers to consider these definitions and strive to tangibly move health research towards equity both in the topics we study and in the ways we do research.

"Oh, you're my health care provider?" Recounting the experiences of people of African descent in Nova Scotia pursuing or working in health professions.

BACKGROUND: Increasing, supporting and cultivating diversity in health programs is key to addressing health inequities. We sought to investigate barriers and facilitators that could affect enrolment and success in health professions among people of African descent in Nova Scotia, Canada. METHODS: We conducted semistructured interviews with people who self-identified as being of African descent who resided or grew up in Nova Scotia, who were working in or pursuing a career in a health profession, and who had participated in culturally specific mentorship programs. Semistructured interviews explored participant experiences that shaped their pursuit of a health profession, as a person of African descent. We thematically analyzed transcribed interviews using constructivist grounded theory. RESULTS: We interviewed 23 participants. Thematic coding showed 4 major themes. The theme of "stand on my shoulders" spoke to the importance of mentorship within the Black community. "Growing through pain" spoke to resilience amidst race-related challenges. "Never the student; ever the teacher" showed the repeated need to educate on issues of race or diversity. The final theme, "change," highlighted next steps, including the need for improvement in curricula, for development of Black faculty and for initiatives that offer support. INTERPRETATION: We found that mentorship, particularly within the community, was instrumental to promoting feelings of belonging. However, participants described the need for resilience in the face of discrimination during training and in practice in health care professions. Rather than focusing on their education, many had to educate those around them. Increased representation, support programs and updated curricula are needed to promote change.