Exploratory Research in Clinical and Social Pharmacy 13 (2024) 100422
Available online 11 February 2024
2667-2766/© 2024 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by- nc-nd/4.0/).
Translating research into a relevant education activity to fulfil pharmacists ’ continuing professional development requirements
Joanna Hikaka
a,*, Nora Parore
a, Brendon McIntosh
a, Robert Haua
a, Kate Mohi
b, Anneka Anderson
caNg¯a Kaitiaki o Te Puna Rongo¯a o Aotearoa – The M¯aori Pharmacists’ Association, Taup¯o, New Zealand
bSchool of Pharmacy, University of Auckland, Auckland, New Zealand
cNational Hauora Coalition, Auckland, New Zealand
A R T I C L E I N F O Keywords:
Culturally safe practice
Continuing professional development Indigenous health
A B S T R A C T
Background: In New Zealand (NZ), provision of culturally safe care by pharmacists is mandated, including an expectation of understanding issues relevant to M¯aori, the Indigenous people of NZ, yet there are few pharmacy- specific resources to support attainment.
Objectives: To: i) test whether a research-informed education activity (short video summarising research findings plus reflective exercises) meets NZ pharmacists’ annual continuing professional development requirements including those relating to culturally safe care ii) identify suggested improvements to the education activity; and iii) identify individual pharmacists’ proposed actions in response to reflection prompted by the education activity.
Methods: Previous research was utilised to develop an education activity (short, animated research summary video and reflective questions). Participants (NZ-registered pharmacists or intern pharmacists) were asked to watch the video and respond to questions online related to perceived relevance and usefulness of the video to informing practice and meeting CPD requirements. Simple descriptive analysis (quantitative data) and general inductive thematic analysis (qualitative data) were applied to the research data.
Results: Thirty-three people participated from Nov-Dec 2022. Most participants said the video was relevant/very relevant to practice (91%), that the reflective exercise was very or extremely useful (100%) and that it met their CPD requirements as relevant to cultural safety (100%).
Conclusion: The education activity appeared to be an appropriate and relevant for CPD and was seen to be concise and exposed ideas in a logical and succinct manner with the potential to benefit the populations receiving care from these providers.
1. Introduction
Continuing professional development (CPD) has been defined as ‘the systematic maintenance, improvement and continuous acquisition and/
or reinforcement of the lifelong knowledge, skills and competences’.1 For many health professionals internationally, CPD is a mandated requirement for annual recertification2–4 and this includes pharmacists in Aotearoa New Zealand (NZ).5 Pharmacists in NZ are required to declare that they have undertaken a variety of CPD activities relevant to Pharmacist Competency Standards each year, and to provide evidence of this (Table 1.)
In 2012, the NZ Pharmacy Council (the national pharmacist
regulatory body) mandated that pharmacists were required to practice in a culturally safe manner which includes a requirement to ‘Understand Hauora M¯aori (M¯aori health and wellbeing)’,5 and provide evidence of related CPD activities. The explicit focus on M¯aori within the compe- tency standards reflects the right of M¯aori, as guaranteed in NZ’s founding document, Te Tiriti o Waitangi, to experience culturally safe care and equitable health outcomes.6 Despite these rights, Maori expe-¯ rience inequitable access to health care and inequitable health outcomes across the clinical spectrum, including pharmacy services and those relating to medicines.7–9
Culturally safe practice requires practitioners to examine the impact that their own culture could have on healthcare delivery and to address
* Corresponding author at: Te Kupenga Hauora M¯aori, University of Auckland, 93 Grafton Rd, Auckland, New Zealand.
E-mail address: [email protected] (J. Hikaka).
Contents lists available at ScienceDirect
Exploratory Research in Clinical and Social Pharmacy
journal homepage: www.elsevier.com/locate/rcsop
https://doi.org/10.1016/j.rcsop.2024.100422
Received 18 December 2023; Received in revised form 6 February 2024; Accepted 8 February 2024
their biases, requiring ongoing critical self-reflection,10 an example of reflective practice. Reflective practice has been encouraged for decades in health professional practice and CPD literature with the current ed- ucation guided by the principles of experiential learning.11 CPD activ- ities which support and encourage reflective practice within the context of culturally safe care are needed to support ongoing pharmacist pro- fessional development. Although research relating to Maori experiences ¯ and expectations of pharmacy and medicines-related care is continuing to increase,12–16 there are few examples of this research being used to develop CPD activities relevant to culturally safe care.
The objectives of this study were to i) test whether a research- informed education activity (short video summarising research find- ings plus reflective exercises) meets NZ pharmacists’ annual continuing professional development requirements including those relating to culturally safe care ii) identify suggested improvements to the education activity; and iii) identify individual pharmacists’ proposed actions in response to reflection prompted by the education activity.
2. Method
2.1. Development of the education activity
Research findings from a larger project focusing on M¯aori experi- ences of medicines adherence15 and minor ailment treatment access14 were summarised by JH and BM and key messages identified. The key messages were then used to develop a short (8mins), animated video using the Upwork.com platform (Available at: https://www.youtube.
com/watch?v=253F8YQfRrQ&t=1s). Pharmacists in NZ are required to provide evidence of reflection on practice, and therefore, reflective questions were developed to accompany the video. Together the video and reflective questions were called the ‘education activity’ (Fig. 1.).
Reflective questions were developed by JH, a pharmacist with experi- ence of developing education activities that meet the NZ pharmacist CPD requirements. After completion of the activity, pharmacists could download the reflective questions and their responses to the questions as evidence of completion of the CPD activity to meet the NZ pharmacist certification evidence requirements.
2.2. Participant recruitment and consent
Email invitations were sent to potential participants through researcher networks, and the pharmacy section of a large primary health provider and through the Pharmaceutical Society of New Zealand (PSNZ), NZ’s largest pharmacy professional body. Snowballing was utilised in this approach.17 Participant Information Sheets were attached
any further questions. The study was open for a 5-week period in November–December 2022. People could use and complete the educa- tion activity after this time; however, their responses were not included in the results.
2.3. Data collection
Upon consenting, the participants were directed to an electronic link to complete the education activity and an online survey in Qualtrics®. The participants were asked to undertake the education activity. After completing the activity, participants were asked a series of questions regarding their demographics and their perceptions on usefulness and relevance of the video and education activity as a whole using a 4-point Likert scale (Extremely useful/relevant – useless/irrelevant). Attain- ment of new knowledge, suggestions for improvement to the education activity, reflections on practice (changes required; alignment with par- ticipants’ own cultural value) and barriers of implementing changes were collected using free text responses. Yes/no questions were used to ask whether the education activity met participants’ CPD requirements (See survey questions in Supplementary material). The reflective exer- cise and survey were piloted by four pharmacists and two undergraduate pharmacy students for face and content validity with only minor ad- justments required. Survey responses were anonymised to minimize any risk of bias and maintain confidentiality.
2.4. Data analysis
Descriptive statistics (e.g., number, proportion, mean, median) were used to describe the quantitative data. Responses to free text survey responses were grouped under each research questions and coded by KM. A general inductive approach was used to develop key concepts within each survey question, similar to Thomas’ approach to thematic analysis.18 These concepts were presented to the wider research team for consensus building and theme finalisation. In accordance with Thomas’
approach to the reporting of general inductive thematic analysis, quotes have been used to illustrate meaning of themes.18
2.5. Ethics
Ethics approval was given by the NZ Health and Disability Ethics Committee (21/CEN/152) prior to the commencement of this research project.
3. Results
During the study period November–December 2022, 59 people started the survey and after discarding responses from those who only completed demographic questions, 33 participant responses were included in the analysis. Only 22 participants completed all questions and so ‘n’ is included in tables and figures to indicate the number of people who responded to each question. Ninety percent (n = 30) of participants were female, the median age was 45 (range 22–71). Par- ticipants from 9 of the 20 regions in NZ were represented. Participants had worked in pharmacy for a median of 22.5 years (range 2–48 years), and the majority (n = 24; 72%) primarily worked in a community pharmacy (Table 2).
Most participants said the video was relevant or very relevant to practice (91%) and all participants stated that the reflective exercise was very or extremely useful (100%). Participants would recommend both the video and reflective exercise to others (82% and 91% respectively;
Fig. 2). All participants stated that the education activity met their CPD requirements relating to cultural safety, and it met the ‘keeping up to Table 1
New Zealand annual continuing professional development requirements for pharmacists.
Activity Number
required
Professional development plan for the year 1
Complete professional development cycle 2
Write a reflective account of performance or reflect crucially on
critical incident 1
Participate in professional meetings 2
Take an action towards cultural safety 1
Take an action to keep up to date 1
Conversations with verifier* about your professional development 2 Verifier* confirms professional development has been relevant to
your role. 1
*A verifier is an experienced registered pharmacist familiar with your type of practice. An individual’s verifier acts in this role for the accreditation year.
Step Four:
Fig. 1.Education activity and research data collection steps.
commenting that it was succinct, and that information was communi- cated in a clear and straight-forward manner, making it easy to under- stand. The accessibility of the content and relevance to every day practice provided further benefit with one participant noting that the broad range of topics covered allowed them to easily reflect on their practice. The incorporation of te reo M¯aori (M¯aori language) and M¯aori concepts was also highlighted as a benefit by several participants.
“It was well presented with good explanation of M¯aori words and values.
Nice and concise and will be a good resource for staff training” (P25, Female, 42 years).
In response to the question of how the video could be improved, several participants thought further information about the definitions and principles of rongo¯a M¯aori (M¯aori medicines/health practices) could be included to increase their understanding of what rongo¯a M¯aori incorporates. It was also suggested that more time could be allowed to read slides that contained participant quotes, and that splitting the video into numerous, shorter videos would be beneficial. Some respondents noted that they would benefit from being informed about steps to create change in response to the issues raised by the video.
“Tips on how we can help more would be good, not just the stats.” (P4, Female, 39).
Despite some participants wanting further advice on practical changes that could be made, many were able to identify activities they would like to undertake in response to the education activity including making pharmacists available to the community outside of the physical pharmacy setting and providing information to promote better under- standing of medicines.
“Remember to treat each patient as if it’s their first prescription and counsel thoroughly” (P13, female, 42).
One participant stated that they would share the video with col- leagues to increase their understanding of the issues, others stated they would act to increase their understanding of the issues and aspirations of their own communities.
Participants were asked what current barriers existed that may hinder the ability to undertake the actions the identified. Multiple re- spondents noted time and staffing issues to be a significant barrier. Cost and resource availability are also factors that diminished the ability to implement the actions.
“Current workload is very high and current staffing does not always allow me to spend as much time as I would like” (P30, female, 47).
Participants were asked ‘What, if any, information from the video differed from your own cultural values or beliefs’. Many participants stated that the M¯aori values and experiences discussed in the video, particularly those around stockpiling medicines, wanting to be treated with respect, and being given appropriate, health-related information were the same as their own cultural experiences and expectations, and Table 2
Participant demographics (n =33).
Characteristic Measure Response (n =33)
Age (years) 21–30 3
31–40 6
41–50 12
51-plus 12
Ethnicity M¯aori 4
Asian 4
NZ European/European 25
Role Pharmacist 32
Intern Pharmacist 1
Work in pharmacy currently? Yes 28
No 5
Region of work Auckland 4
Waikato 2
Bay of Plenty 1
Tair¯awhiti 2
Wellington 10
Nelson/Tasman 2
Lakes 3
Canterbury 4
Otago 4
Not stated 1
Work setting Community Pharmacy 24
Hospital 4
Academia 1
Primary Care Organisation 1
Aged Residential care 1
Government 1
Health Research 1
Years in pharmacy Less than 5 1
5–10 2
11–20 10
21–30 11
31-plus 8
Not stated 1
aligned across all cultures. Providing M¯aori with time and health in- formation was the most common way in which participants felt power imbalances in the pharmacy setting could be addressed. The role of wh¯anau (family) in medicine-related care for M¯aori differed to that of several participants who, instead received health care as an individual.
Most participants who expressed this reflected positively on the differ- ence, noting that the education activity increased their understanding of the role of wh¯anau in health care. In contrast, one participant felt wh¯anau involvement and support in care removed individual re- sponsibility and was potentially detrimental to good health outcomes.
Individuals should be given the information and tools to manage their own health and medicines, unless there’s a specific reason why. Understanding their own health may make them more compliant. Some patients just don’t care, and they rely on their wh¯anau to organise everything for them (P4, Female, 39).
Several participants noted that the association of stigma with some conditions differed to their experiences both professionally and personally.
“The outcome that ‘if services were targeted towards Maori that this could ¯ increase stigma’. This is something I hadn’t heard before, but now that I’ve heard it, I completely understand the sentiment.” (P6, female, 45).
4. Discussion
The approach used to translate research findings into an education activity appeared to be useful, relevant, and met pharmacists’ CPD re- quirements, with all participants stating it fulfilled CPD requirements as relevant to cultural safety. The video was seen to provide succinct key messages which promoted reflection on pharmacists’ cultural and clin- ical practices. Some easily addressable improvements to the content and length of the video were suggested. Pharmacists could identify actions they take in response to the education activity although lack of time and other workforce demands were perceived as barriers to implementation.
As CPD relates to ongoing personal development, and should be relevant to an individual’s current educational level, identified need, and their area of practice,2 the type of activities undertaken can vary significantly between pharmacists. It is therefore significant that most participants stated this education activity met their CPD requirements.
Previous literature has identified that pharmacists find CPD self- assessment complex,19,20 and the majority of pharmacists do not use competency standards as a basis for self-assessment.19 The education activity used in the current study included relevant competency stan- dards which may have improved pharmacists’ ability to self-assess competency.19 Addition of competency standards to CPD education activities may be important for future CPD development, although a recent large scoping review exploring the use of learning needs assess- ments in CPD found limited evidence to support their use, despite this being a central recommendation in CPD literature.21
Culturally safe practices by health care professionals have been identified as essential components of health care standards to address inequities in health care outcomes between Indigenous and non- Indigenous peoples.22,23 Cultural safety education has reported bene- fits relating to improved advocacy for Indigenous peoples, improved partnerships with Indigenous communities and changing practices to support Indigenous self-empowerment,24 although the extent to which a one-off brief activity could instigate these changes is unclear. And more generally, there is ongoing debate about the extent to which CPD does, or does not, lead to actions, change in practice, or ultimately improve patient wellbeing.25
The education activity developed in the current study guided phar- macists to reflect on new learning, informed by the voices of M¯aori communities and developed into key messages by M¯aori researchers.
Even within formal undergraduate and postgraduate Health Sciences curricula, inclusion and leadership by Indigenous people is often lacking
in the development of cultural safety education despite being recognised as important.24 Participants were asked to explicitly compare the research findings to their own culture and values; understanding that one’s own culture and experiences may differ to another’s is central to cultural safety.10 However, merely understanding that differences exist does not necessarily translate into culturally safe practice, which re- quires understanding power dynamics in engagement processes.26
Although pharmacists were able to identify the need to undertake actions, the wider health system within which pharmacists operate also needs to be considered. Many of the participants felt constrained by time pressures both personally and for the wider staffing team which reduced their confidence in being able to apply the identified actions. Pharma- cists work within a wider pharmacy team and the importance of increasing the scope of other staff, such as pharmacist technicians, has the potential to improve the level of service offered from pharmacies.27 The majority of participants in this study discussed the education ac- tivity with pharmacy staff and there is the potential the resource has applicability beyond pharmacist CPD and into education for the entire pharmacy team.
4.1. Strengths and limitations
This paper provides guidance for others wishing to translate health research into practitioner education resources. The NZ Pharmacy Council does not endorse or verify any CPD activities or organisations to deliver CPD; it is therefore incumbent upon pharmacists themselves to assess CPD relevance of education activities, a practice which was replicated in the evaluation in this study. There is the potential that only those interested in this topic participated in the research however, given there are few CPD resources relating to cultural safety in the NZ phar- macy sector, people may have participated in the research because it gave them access to a learning resource. In fact, a further 50 pharmacists completed the activity in the 3 months after the study closed and the video has been viewed 378 times in the 10 months post-study. There are a number of limitations to this study, including low participant numbers and therefore a lack of generalisability across the NZ pharmacist pop- ulation. The encouraged use of reflective practice for CPD postulates that learning occurs through a process of transforming experiences into ideas that can be reflected upon and applied to situations.28 Although this education activity asked pharmacists to reflect on their practice and propose changes to practice, it did not investigate whether the education activity led to transformative change in the real-world. Other limitations were those interpreting the data were involved in the creation of the resource and part of the research team undertaking the wider research project which could lead to bias; not all participants answered all questions; participants could have falsely stated this activity met their CPD requirements in order to be able to submit evidence of completion for CPD requirements, and the requirement for written (rather than verbal) responses may have limited participants’ willingness to provide full and rich responses to questions.
5. Conclusion
The approach used to translate research findings into an education activity appeared to be useful, relevant, and met pharmacists’ CPD re- quirements and guided pharmacists to reflect on new learning, informed by the voices of M¯aori communities. The methods used in this project can be applied broadly across the pharmacy and wider health care professions to support research-informed CPD.
Funding
This funding is supported by the Health Research Council of New Zealand (HRC: 20/1466) and Pharmac. The funders had no role in study design, analysis or interpretation of results.
Author contributions
JH: Conceptualization, formal analysis, methodology, data curation, project administration, supervision, writing – original draft, funding acquisition; NP: Formal analysis, supervision, Writing – review and editing; BM: Methodology, Writing – review and editing; RH: Writing – review and editing; KM: data curation; formal analysis, Writing – review and editing; AA: Writing – review and editing.
CRediT authorship contribution statement
Joanna Hikaka: Writing – original draft, Supervision, Project administration, Methodology, Funding acquisition, Formal analysis, Data curation, Conceptualization. Nora Parore: Writing – review &
editing, Methodology, Formal analysis. Brendon McIntosh: Writing – review & editing, Methodology. Robert Haua: Writing – review &
editing. Kate Mohi: Writing – review & editing, Formal analysis, Data curation. Anneka Anderson: Writing – review & editing.
Declaration of competing interest
The authors have no conflicts of interest to declare.
Acknowledgements
Thank you to those who participated in this study for your time and knowledge. Thank you to Kayode Abiodun for your support in creating the video used as part of the education activity; research participants for your time; Mariana Hudson, Kevin Pewhairangi, Rachel Brown and Pauline Te Karu for your support of the broader research project.
Appendix A. Supplementary data
Supplementary data to this article can be found online at https://doi.
org/10.1016/j.rcsop.2024.100422.
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