OTCs Today
Daniel L. Krinsky, RPh, MS
Cultural and diversity issues are front and center in today’s society. Importantly, they often affect patients’ acceptance of and adherence to self-care treatment plans, which include a range of individual health behaviors, such as health maintenance, use of preventive services, symptom evaluation, self-treatment, interaction with health care providers, and seeking advice through lay and alternative care networks.
Demographic shifts in the U.S. population, from age, race, and language to religion, disability status, sexual orientation, in addition to other cultural group changes, affect the approach and delivery of care to patients.
Minority populations—including patients from diverse races and ethnic groups, women, people with disabilities, LGBTQ+ people, and older adults—have experienced a range of health disparities. These health disparities occur when differences or gaps exist in health determinants, health access, and/or health outcomes among particular populations or groups that have experienced marginalization.
Barriers to self-care
Differences in patients’ language and health literacy; access, capacity, and motivation to take care of themselves; perceived health status; and confidence to take care of themselves pose barriers that can apply to self-care. Mistrust and fear of the U.S. health care system and its providers can prevent some minority-population patients from seeking self-care. Reducing mistrust requires repeated positive encounters over time. Low-level health literacy makes it difficult for providers to rely on using existing nonprescription labels to give to patients.
The inability to speak or read English makes it difficult for many patients to communicate with their health care provider or to read instructions on nonprescription labels that are only in English. Limited English proficiency creates a significant barrier to seeking self-care or the advice of a provider when services are only delivered in English. Patients may rely on information from television or magazines written in their language of origin, or on the recommendations of family members, relatives, or community leaders. Although many community pharmacies have telephone-based interpreter services available, patients who are making self-care decisions in the aisle of the pharmacy may not be aware of this service and may not request assistance from the provider.
Serving a culturally diverse community
When collecting information from patients, providers should gain an understanding of patients’ perspectives on causes, treatment, and concerns specific to their situation. Formulation of a successful and appropriate self-care plan for a given health issue is best achieved by incorporating the patient’s health beliefs and behaviors as a key component. Providers who can work across diverse cultural groups can support patients in making self-care decisions. Interactions that are culturally and linguistically sensitive, respectful, and competent can positively affect the quality of care for patients in diverse populations. Communicating within the framework of the patient’s culture helps break down barriers while also facilitating trust and understanding between the patient and the provider. Through verbal and/or written communication with the patient, an interpreter, or an adult family member, providers must ensure that the patient understands the instructions and/or product label directions.
Self-care behaviors have not been well-described among different population groups. Self-care practices in many cultural groups involve the use of home remedies, herbs, massage therapy, acupuncture, or other treatments that are passed from generation to generation. It is important to understand how these may contribute to decisions about managing self-care conditions. The improper use of nonprescription products places vulnerable populations at an increased risk for negative outcomes. The potential for misuse of drugs that are available for self-treatment may outweigh the benefit for some patients.
Health care providers should assess and evaluate their own values and beliefs about cultures while acquiring knowledge and skills to deliver effective care for patients from diverse cultures and backgrounds. When assisting patients with their self-care needs, providers should include the cultural values, behaviors, and beliefs expressed by the patient. Take the time to get out from behind the counter and find ways to serve your culturally diverse community.