Margarita Echeverri

Assessing Pharmacy Students' Self-Perception of Cultural Competence

Pharmacists play an increasingly important role in medication therapy management, which requires communicating effectively with patients. Pharmacy students completed the Self-Assessment of Perceived Level of Cultural Competence (SAPLCC) questionnaire, and their results were used to identify patterns in self-assessment of cultural competence. In general, students rated their knowledge as less than their skills and attitudes. Important differences were found by race, comparing each group with its counterparts: African American students rated their perceived competencies regarding patient discrimination and barriers to health care at a significantly higher level; Asian American students rated their attitudes to engaging in self-reflection and their knowledge in multicultural issues at significantly lower level; and White students rated their awareness regarding racial dynamics at a significantly lower level. It is recommended to consider the students’ cultural, racial, and ethnic backgrounds before developing curriculum in cultural competence and, perhaps, to develop targeted educational interventions for specific groups.

Cancer Health Literacy Test-30-Spanish (CHLT-30-DKspa), a New Spanish-Language Version of the Cancer Health Literacy Test (CHLT-30) for Spanish-Speaking Latinos

This article describes the adaptation and initial validation of the Cancer Health Literacy Test (CHLT) for Spanish speakers. A cross-sectional field test of the Spanish version of the CHLT (CHLT-30-DKspa) was conducted among healthy Latinos in Louisiana. Diagonally weighted least squares was used to confirm the factor structure. Item response analysis using 2-parameter logistic estimates was used to identify questions that may require modification to avoid bias. Cronbach’s alpha coefficients estimated scale internal consistency reliability. Analysis of variance was used to test for significant differences in CHLT-30-DKspa scores by gender, origin, age and education. The mean CHLT-30-DKspa score (N = 400) was 17.13 (range = 0–30, SD = 6.65). Results confirmed a unidimensional structure, χ2(405) = 461.55, p = .027, comparative fit index = .993, Tucker–Lewis index = .992, root mean square error of approximation = .0180. Cronbach’s alpha was .88. Items Q1-High Calorie and Q15-Tumor Spread had the lowest item–scale correlations (.148 and .288, respectively) and standardized factor loadings (.152 and .302, respectively). Items Q19-Smoking Risk, Q8-Palliative Care, and Q1-High Calorie had the highest item difficulty parameters (difficulty = 1.12, 1.21, and 2.40, respectively). Results generally support the applicability of the CHLT-30-DKspa for healthy Spanish-speaking populations, with the exception of 4 items that need to be deleted or revised and further studied: Q1, Q8, Q15, and Q19.

A Revised Scale of Cultural Competence Curriculum in Pharmacy Education: A Multi-School Validation Trial

Objective. To revise the Self-Assessment of Perceived Level of Cultural Competence (SAPLCC) instrument and validate it within a national sample of pharmacy students. Methods. A cross-sectional study design using a convenience sample of pharmacy schools across the country was used for this study. The target population was Doctor of Pharmacy (PharmD) students enrolled in the participating pharmacy programs. Data were collected using the SAPLCC. Exploratory factor analysis with principal components extraction and varimax rotation was used to identify the factor structure of the SAPLCC instrument. Results. Eight hundred seventy-five students from eight schools of pharmacy completed the survey. Exploratory factor analysis resulted in the selection of 14 factors that explained 76.6% of the total variance and the grouping of 75 of the 86-items in the SAPLCC into six domains: knowledge (16 items), skills (11 items), attitude (15 items), encounters (11 items), abilities (13 items), and awareness (9 items). Using a more diverse, representative sample of pharmacy students resulted in important revisions to the constructs of the SAPLCC and allowed the identification of a new factor: social determinants of health. Conclusion. The 75-item SAPLCC is a reliable instrument covering a full range of domains that can be used to measure pharmacy students’ perceived level of cultural competence at baseline and upon completion of the pharmacy program.

Cancer Health Literacy and Willingness to Participate in Cancer Research and Donate Bio-Specimens

Although it has been well documented that poor health literacy is associated with limited participation in cancer clinical trials, studies assessing the relationships between cancer health literacy (CHL) and participation in research among diverse populations are lacking. In this study, we examined the relationship between CHL and willingness to participate in cancer research and/or donate bio-specimens (WPRDB) among African Americans, Latinos, and Whites. Participants completed the Cancer Health Literacy Test and the Multidimensional Cancer Literacy Questionnaire. Total-scale and subscale scores, frequencies, means, and distributions were computed. Analyses of variance, the Bonferroni procedure, and the Holm method were used to examine significant differences among groups. Cronbach’s alphas estimated scales’ internal consistency reliability. Significant interactions were found between race/ethnicity, gender, and CHL on WPRDB scales and subscale scores, even after education and age were taken into account. Our study confirms that CHL plays an important role that should be considered and researched further. The majority of participants were more willing to participate in non-invasive research studies (surveys, interviews, and training) or collection of bio-specimens (saliva, check cells, urine, and blood) and in studies led by their own healthcare providers, and local hospitals and universities. However, participants were less willing to participate in more-invasive studies requiring them to take medications, undergo medical procedures or donate skin/tissues. We conclude that addressing low levels of CHL and using community-based participatory approaches to address the lack of knowledge and trust about cancer research among diverse populations may increase not only their willingness to participate in research and donate bio-specimens, but may also have a positive effect on actual participation rates.

AACP Special Taskforce White Paper on Diversifying Our Investment in Human Capital

EXECUTIVE SUMMARY The 2015-2017 American Association of Colleges of Pharmacy (AACP) Special Taskforce on Diversifying our Investment in Human Capital was appointed for a two-year term, due to the rigors and complexities of its charges. This report serves as a white paper for academic pharmacy on diversifying our investment in human capital. The Taskforce developed and recommended a representation statement that was adapted and adopted by the AACP House of Delegates at the 2016 AACP Annual Meeting. In addition, the Taskforce developed a diversity statement for the Association that was adopted by the AACP Board of Directors in 2017. The Taskforce also provides recommendations to AACP and to academic pharmacy in this white paper.

Racial Dynamics and Cultural Competence Training in Medical and Pharmacy Education

Using the Self-Assessment of Perceived Level of Cultural Competence (SAPLCC) questionnaire, frequencies, means, and ANOVAS were determined to create medical and pharmacy student profiles of cultural competence. Profiles were used to identify needs for training and underscore critical issues that should be given priority in the curriculum. Significant differences were found in several domains of cultural competence (knowledge, skills, attitudes, and abilities); they may be explained by differences in the implementation of a pilot curriculum, the racial composition of students in both programs, and other characteristics. However, in the awareness domain, the main differences found may be explained only by respondents’ attitudes and their personal experiences. Results confirm the importance of examining the racial dynamics factor and the need to address this sensitive topic early in the academic programs so students are prepared more fully to have sincere and meaningful encounters with their patients during the clinical years and as health care providers.

Assessing Cancer Health Literacy among Spanish-Speaking Latinos

Health literacy is a dynamic construct that changes with specific health conditions; thus, new disease-specific health literacy tools are needed. Since cancer is the leading cause of death among Latinos, the largest and fastest-growing minority population in the nation, there is a need to develop tools to assess cancer health literacy (CHL) among the Spanish-speaking population. The Cancer Health Literacy Test, Spanish version (CHLT-30-DKspa) was applied to identify Spanish-speaking individuals with low CHL and ascertain which items in the tool best discriminate between CHL level groups. Cross-sectional field test of the CHLT-30-DKspa among Spanish-speaking Latinos. Latent class analysis (LCA) identified participants with varying CHL levels. Probability of correct answers, odds ratios, and standardized errors were used to identify the items that allow the classification of individuals among the latent classes. LCA resulted in a three-latent-class model predicting 39.4% of participants to be in the HIGH class, 43.3% in the MEDIUM class, and 17.3% in the LOW class. Eleven items (the CHLT-11-DKspa) meet the criteria to clearly separate participants with HIGH and LOW classes of CHL. Although the best model fit was a three-class solution, results showed a clear separation of individuals from HIGH versus LOW levels of CHL, but separation of those in the MEDIUM level was not as clear. The CHLT-11-DKspa is a shorter measure that may be relatively easy to use in a clinical encounter to identify Spanish-speaking patients with the poorest levels of CHL who may require additional support to understand medical instructions and care plans.

Developing Best Practices for Instruction in Cultural Competence: A Pilot Project

• Changes in U.S. population demographics characteristics require the preparation of culturally diverse competent healthcare providers who are capable of practicing in an increasingly diverse society.1 • Training in cultural diversity competence has been recognized as a pre-requisite to fostering the transformation of healthcare1 • As response, the accreditation agencies of health-related academic programs have included new requirements of implementing cultural diversity competence along the curriculum.2,3 • Although demonstration of students’ cultural diversity competence and multicultural communication skills are required in most of the accreditation standards for healthrelated programs, more evidence is needed to determine the best teaching and learning practices for achieving these competencies.A Program to Foster Global Citizenship in Pharmacy Education. Ana Maria Castejon, Nova Southeastern University, Dawn Dacosta, Nova Southeastern University, Jaroslav Toth, Comenius University in Bratislava, Jan Kyselovic. Objectives: Understanding the practice of pharmacy from a global perspective is not a traditional curricular outcome in most US pharmacy programs. The objective of this CoCurricular activity was to provide students with an understanding, and appreciation for pharmaceutical and medical practices outside the UnitedStates. A total of 35 student pharmacists participated in aTravel Study Program (TSP) to Slovakia during the summer of 2013 at Comenius University in Bratislava, Slovakia. Topics covered included pharmacognosy, molecular drug design, European pharmaceutical regulatory agencies and the practice of the profession in Slovakia and the European Union (EU). Live lectures, laboratory practices at the host institution together with multiple site visits to different professional practice settings were included in the TSP. Through reflective exercises we assessed the students’ ability to: 1. Compare the practice of pharmacy in the US versus Slovakia and the EU 2. Identify the professional benefits of attending a structured pharmacy TSP Method: The 35 students completed reflective academic assignments and cultural competency activities before and after the three-week visit to Bratislava. The students’ reflective exercises were analyzed using narrative and content analysis, allowing us to capture the multiple meanings and dimensions of the experiences. Results: The students’ narrations reflected a major impact on their professional growth, intercultural sensitivity and competencies. Participants identified major differences in legal and regulatory aspects of the profession. They highlighted the establishment of connections and international learning networks. Implications:We believe that these programs promote global citizenship, while fostering learning and cultural exchange within the pharmacy profession.

Pilot-testing of a Protocol to Determine Best Practices in Health Literacy Education

• Changes in U.S. population demographics characteristics require the preparation of culturally diverse competent healthcare providers who are capable of practicing in an increasingly diverse society.1 • Training in cultural diversity competence has been recognized as a pre-requisite to fostering the transformation of healthcare1 • As response, the accreditation agencies of health-related academic programs have included new requirements of implementing cultural diversity competence along the curriculum.2,3 • Although demonstration of students’ cultural diversity competence and multicultural communication skills are required in most of the accreditation standards for healthrelated programs, more evidence is needed to determine the best teaching and learning practices for achieving these competencies.A Program to Foster Global Citizenship in Pharmacy Education. Ana Maria Castejon, Nova Southeastern University, Dawn Dacosta, Nova Southeastern University, Jaroslav Toth, Comenius University in Bratislava, Jan Kyselovic. Objectives: Understanding the practice of pharmacy from a global perspective is not a traditional curricular outcome in most US pharmacy programs. The objective of this CoCurricular activity was to provide students with an understanding, and appreciation for pharmaceutical and medical practices outside the UnitedStates. A total of 35 student pharmacists participated in aTravel Study Program (TSP) to Slovakia during the summer of 2013 at Comenius University in Bratislava, Slovakia. Topics covered included pharmacognosy, molecular drug design, European pharmaceutical regulatory agencies and the practice of the profession in Slovakia and the European Union (EU). Live lectures, laboratory practices at the host institution together with multiple site visits to different professional practice settings were included in the TSP. Through reflective exercises we assessed the students’ ability to: 1. Compare the practice of pharmacy in the US versus Slovakia and the EU 2. Identify the professional benefits of attending a structured pharmacy TSP Method: The 35 students completed reflective academic assignments and cultural competency activities before and after the three-week visit to Bratislava. The students’ reflective exercises were analyzed using narrative and content analysis, allowing us to capture the multiple meanings and dimensions of the experiences. Results: The students’ narrations reflected a major impact on their professional growth, intercultural sensitivity and competencies. Participants identified major differences in legal and regulatory aspects of the profession. They highlighted the establishment of connections and international learning networks. Implications:We believe that these programs promote global citizenship, while fostering learning and cultural exchange within the pharmacy profession.