Addressing cultural competence and bias in treating migrant workers in pharmacies: Pharmacy students learning and changing norms.

Abstract

Little research addressed training pharmacy students on bias towards vulnerable patients such as migrant domestic workers (MDWs). This study evaluates a module addressing bias and cultural competence when working with MDWs in community pharmacies. Two cohorts of Lebanese Bachelor of pharmacy students completed this module as part of a core Public Health class. Guided by a social psychology framework, the module involved watching a lecture, discussing an article, watching a video addressing bias in healthcare, and taking an Implicit Association Test. Second, students interviewed one MDW and one pharmacist before filling a reflection worksheet. Students' reflections were analyzed qualitatively using content analysis. Further, to evaluate the module's impact quantitatively, an aggregate perception of helpfulness scale was created and validated. Items addressed students' own experience with the module as well as its impact on pharmacists interviewed by students. Of 170 students completing the module and providing qualitative data, 131 were asked to fill a survey addressing perceptions of assignment helpfulness. Of those 131 students, 126 filled the survey. On a scale ranging from zero to four, the composite mean score for helpfulness was 3.4, SD=0.5. Students reported a positive impact of the interview in improving awareness of bias for pharmacists they interviewed (mean=3.5, SD=0.6). Qualitative analysis produced insight into students' experience with the module including challenges in communication with MDWs; MDWs' experience with bias and its repercussions; predictability, or lack thereof, of assignment results; plans to address bias after taking the module; evaluation of interviewed pharmacist's service; and perceived pharmacists' impressions of the assignment. A two-part module shows promise in educating pharmacy students about bias and cultural competence. Engaging target audience including pharmacists can make such experiences meaningful for students while providing a learning opportunity for those health professionals.