A Cross-Sectional Online Survey: Exploring the patient perspective of community pharmacies delivering care to ethnically diverse individuals with disabilities

A Cross-Sectional Online Survey: Exploring the patient perspective of community pharmacies delivering care to ethnically diverse individuals with disabilities | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Cross-Sectional Online Survey: Exploring the patient perspective of community pharmacies delivering care to ethnically diverse individuals with disabilities Cambrey B Nguyen, Brittany Melton, Kristin Villa This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5314061/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 15 Apr, 2025 Read the published version in International Journal of Clinical Pharmacy → Version 1 posted 6 You are reading this latest preprint version Abstract Background According to the Centers for Disease Control and Prevention (CDC), more than one in four people live with a disability in the US, and 76.8% of adults with disabilities encounter barriers that prevent access to available healthcare. To reduce inequities, healthcare professionals are encouraged to provide patient-centered and culturally responsive care. Aim This study was a prospective, cross-sectional, questionnaire-based study that obtained patient perception of community pharmacies providing culturally responsive care to ethnically diverse patients with disabilities. Methods Respondents were recruited by Qualtrics to complete an anonymous, nationwide, online survey from August 7 to August 14, 2024. The survey asked for demographic information, frequency of encounters with the pharmacy, perception of quality of care based on their identities (ethnicity, disability), barriers in obtaining medications, and suggestions to improve services. Demographics were reported using descriptive statistics and the Kruskal-Wallis test was used to compare Likert scale responses. Results A total of 1218 respondents completed the survey; 200 self-identified as white, non-Hispanic without disabilities which served as the control and 1018 patients were from an ethnically diverse background with a disability (n = 518) or without disabilities (n = 500). Overall, the median age was 41 years and 66% of respondents were female. In all of the cohorts, over 50% of respondents were satisfied with the quality of care provided by pharmacists and pharmacy staff. Barriers identified were communication issues (specific to hearing) and the limited physical space for patients in wheelchairs. Patients suggested increased diversity of staff members in the pharmacy along with training for pharmacists and staff on the needs of those with disabilities. Conclusions Patients reported positive experiences related to their race, ethnicity, and disability status when interacting with the pharmacy; however, many barriers and other considerations were noted by respondents that may improve their care and experiences. Impact Statements This study contributes to the limited research on patient experiences interacting with pharmacy staff and their perceptions of interactions based on their cultural background of race, ethnicity, and disability. Patients with disabilities identified barriers including a lack of physical accommodations and non-verbal communication methods available at the pharmacy. Increasing professional development in cultural intelligence will help pharmacists understand the needs of patients from different cultural backgrounds including those with disabilities along with hiring more diverse staff members. Introduction The Centers for Disease Control and Prevention (CDC) cites over one in four people live with a disability in the United States [ 1 ]. A disability may impact individuals of all ages and racial or ethnic backgrounds, and the subgroup with the highest prevalence of disability among adults over the 18 years of age were American Indian and Alaskan Native at 38.7% based on 2022 data [ 2 ]. Healthy People 2020 reported adults with disabilities encounter barriers that prevent access to available healthcare and other services pertaining to wellness [ 3 ]. Moreover, people with disabilities are more likely to have arthritis, diabetes, and a heart attack along with having unmet medical, dental, and prescription needs compared to those who do not have a disability with these disparities being greater if the individual has a disability and from an ethnically diverse background [ 4 ]. To reduce inequities in healthcare, providers have been encouraged to deliver patient-centered and culturally responsive care through practices which incorporate the patients’ social, cultural, and linguistic needs [ 5 , 6 ]. This concept was acknowledged in the early 2000s from studies that noted patients of diverse backgrounds, specifically racial and ethnic minorities, received lower quality healthcare and poorer health outcomes when compared to non-minority patients due to system and provider biases [ 7 – 9 ]. Cultural competency has been a standard in health education, provider practice, and health system goals to improve equity for individuals from diverse cultural backgrounds (race, age, and disabilities) leading to better patient health outcomes [ 10 – 13 ]. Despite emphasizing cultural competence and integrating these practices into patient care, healthcare professionals have found difficulty incorporating patient traits with culturally competent care and understanding systemic practices including implicit biases [ 14 , 15 ]. In a two phase study evaluated cross-cultural competency of providers in a primary care clinic as perceived by patients of Asian descent with diabetes, and the results showed the cultural competency of providers was inadequate with a significant negative correlation for the providers’ cultural competency score, and the patient’s HbA1C levels [ 16 ]. Another challenge noted in the literature is the feasibility of healthcare professionals to obtain and fully understand the spectrum of every culture due to complexities associated with a culture; therefore, the concept of cultural intelligence domains emerged to encourage not only knowledge but awareness, practice, and desire when providing patient-centered care [ 17 , 18 ]. Although culturally competent care has been shown to be inadequate in medicine, failure to provide culturally intelligent care by pharmacists may have detrimental impact as patients more often visit community pharmacies than other healthcare professionals [ 19 ]. Additionally, pharmacy programs routinely provide instruction on culture and biases aimed to improve care; however, these discussions are often focused on cultural differences of race or ethnicity. Other cultural differences, including disability culture, are often underrepresented in discussions throughout education programs [ 20 ]. Due to the number of contacts and the underrepresentation of certain cultures in educational programs, the cultural intelligence of pharmacists can significantly impact patient health equity, especially at the intersection of race and disability. The literature in the area of evaluating culturally-responsive care of pharmacists and pharmacies to patients is currently limited [ 21 ]. A pilot found the community pharmacists’ attitude was relatively positive toward cultural awareness and sensitivity; however, another study revealed that pharmacists did not have a good understanding of hearing disabilities and deaf culture [ 22 , 23 ]. A recent qualitative study conducted in the UK obtained perspectives of 14 community pharmacy staff members on cultural competency training, and the results showed these individuals recognize there is a need for an inclusive approach to assist patients from different ethnicities by understanding the cultural beliefs that may influence drug therapy, and educating the pharmacy profession in cultural competency within the pharmacy school curriculum [ 24 ]. Aim While there is evidence that pharmacist cultural intelligence can impact patient care, there are few studies exploring patient perceptions of cultural interactions, cultural interactions across multiple groups, and interactions at the intersection of race and disability. This study aims to explore the intersectionality of race and disabilities and patient perception of care provided by pharmacists and other pharmacy staff members. Ethics Approval: University of Kansas Human Research Protection Program provided approval on July 31, 2024 (ID: STUDY00151493). Methods This study was a prospective, cross-sectional, questionnaire using a convenience sample of consumers across the United States. Informed consent was obtained from all individual participants included in the study. Consumers were eligible for this study if they are at least 18 years old, can read and understand English, and can access the survey questions using an electronic device. Additional qualifiers for the study included going to a pharmacy to obtain prescription medications and interacting with the pharmacy staff (e.g., pharmacist, technicians) during the visit. The target responses were at least 1200 and participants were assigned to one of three groups depending on how they self-identified, with white, non-Hispanic participants without a disability serving as the control group and other participants were ethnically/racially diverse and grouped on the presence or absence of a disability. Qualtrics was the online survey provider for the study and was responsible for participant recruitment, survey administration, and data delivery. The survey consisted of demographic information (e.g., age, gender, and race), frequency of interactions with the pharmacy staff, and perception of culturally responsive care delivered by pharmacists and pharmacy staff using a set of Likert scale questions (1 = strongly disagree, 5 = strongly agree). Other questions focused on barriers related to ethnicity and/or disability status as an impact factor on obtaining medications in the community setting and suggestions on how to improve services provided by the pharmacy related to the patient’s culture of ethnicity and disability. Participants identifying as both ethnically diverse and having a disability received an additional question pertaining to the care they receive as it relates to their disability status. The questions consisted of multiple-choice, yes or no, and text-entry (open-ended) questions. The total number of questions presented to participants depended on their demographic response (e.g., those with disabilities were presented with two additional Likert questions). Demographic information was reported using descriptive statistics (mean) and the Likert portion of the survey was reported using median/IQR using SPSS v. 27. The Pearson’s Chi-Square test was used to determine statistical significance of gender distribution, and the Kruskal-Wallis test was used to compare Likert scale ratings along with frequency of interactions with the pharmacist and pharmacy staff among the three cohorts. The level of statistical significance was set at α < 0.05 for all analyses. Qualtrics provided respondents with incentives based on a point system and respondents may redeem their points for awards in the form of gift cards, airline credit, online game credit, etc. Results A total of 1218 people completed the anonymous, nationwide, online survey administered through Qualtrics (Provo, UT) from August 7 to August 14, 2024. and the demographics are provided in Table 1 . Overall, the median age was 41 years and 66% of respondents were female. The distribution of age was statistically significant amongst the control group of white, non-Hispanic without disabilities (n = 200), ethnically diverse without disabilities (n = 500, [non-disability cohort]), and ethnically diverse with disabilities (n = 518, [disability cohort]) (p < 0.001); however, gender was not found to be statistically significant. In the disability and non-disability cohorts (n = 1018), most of the respondents self-reported as Black or African-American and approximately 10% of the respondents had multiple disabilities. Over half of the respondents earned a high school diploma or GED and attended some college with an annual income of less than $ 50,000. The regional geographic representation of the respondents included 20.9% from the Midwest, 17.2% from the northeast, 38.1% from the south, and 23.8% from the west. These percentages were based on the general population as gathered by the census to reflect the percentage of census respondents that live in each region. In the overall population, 47% of participants interact with the employees in the pharmacy and ask pharmacists about their medications on a monthly basis. Less than 17% of participants have interactions with their pharmacy team or speak to a pharmacist weekly. There was a significantly more participants in the disability cohort that talked to pharmacist and staff on a monthly basis compared to the other two cohorts (p < 0.001). Table 1 Demographics of Survey Respondents Demographic All Respondents White, non-Hispanic Ethnically Diverse Without Disability Ethnically Diverse with Disability Age (median, IQR) n = 1213 41 [31–51] 51 [38–65] 37 [29–45] 41 [31–53] Gender N = 1218 n = 197 n = 500 n = 518 Female 807 (66.3%) 141 (70.5%) 331 (66.2%) 335 (64.7%) Race N = 1218 n = 200 n = 500 n = 518 White, non-Hispanic 200 (16.4%) 200 (16.4%) NA NA Asian 79 (6.5%) NA 55 (11.0%) 24 (4.6%) Hispanic, Latinx 154 (12.6%) NA 76 (15.2%) 78 (15.1%) Black or African American 668 (54.8%) NA 328 (65.6%) 340 (65.6%) Native Hawaiian or Pacific Islander 12 (1.0%) NA 5 (1.0%) 7 (1.4%) American Indian or Alaska Native 62 (5.1%) NA 25 (5.0%) 37 (7.1%) Other 43 (3.5%) NA 11 (2.2%) 32 (6.2%) Type of Disability N = 1218 n = 200 n = 500 n = 518 No disability 700 (57.5%) 200 (100%) 500 (100%) NA Deafness or Hard of Hearing 32 (2.6%) NA NA 32 (6.17%) Low vision or Visually Impaired 106 (8.7%) NA NA 106 (20.5%) Motor 82 (6.7%) NA NA 82 (15.8%) Cognitive or Learning 55 (4.5%) NA NA 55 (10.6%) Other 118 (9.7%) NA NA 118 (22.8%) Multiple 125 (10.3%) NA NA 125 (24.1%) Education Status (highest degree) N = 1218 n = 200 n = 500 n = 518 Less than high school degree 69 (5.7%) 8 (4.0%) 22 (4.4%) 39 (7.5%) High School graduate or GED 409 (33.6%) 55 (27.5%) 181 (36.2%) 173 (33.4%) Some college 419 (34.3%) 77 (38.5%) 160 (32.0%) 182 (35.1%) Bachelor’s degree 198 (16.3%) 40 (20.0%) 84 (16.8%) 74 (14.3%) Master’s 80 (6.6%) 16 (8.0%) 35 (7.0%) 29 (5.6%) Professional 29 (2.4%) 3 (1.5%) 12 (2.4%) 14 (2.7%) PhD 14 (1.1%) 1 (0.5%) 6 (1.2%) 7 (1.4%) Annual Household Income N = 1218 n = 200 n = 500 n = 518 < $ 25,000 397 (32.6%) 54 (27.0%) 134 (26.8%) 209 (40.3%) $ 25,000- $ 34,999 219 (18.0%) 29 (14.5%) 98 (19.6%) 92 (17.8%) $ 35,000- $ 49,999 176 (14.4%) 38 (19.0%) 77 (15.4%) 61 (11.8%) $ 50,000- $ 74,999 207 (17.0%) 40 (20.0%) 86 (17.2%) 81 (15.6%) $ 75,000- $ 99,999 114 (9.4%) 21 (10.5%) 60 (12.0% 33 (6.4%) $ 100,000- $ 149,999 69 (5.7%) 13 (6.5%) 29 (5.8%) 27 (5.2% > $ 150,000 36 (3.0%) 5 (2.5%) 16 (3.2%) 15 (2.9%) The perceptions of pharmacy care based on a Likert scale are reported in Table 2 . Overall, over 50% of respondents were satisfied with the quality of care provided by pharmacists and pharmacy staff based on the individual Likert items. Patients with disabilities also agreed the pharmacy staff is knowledgeable and can answer questions about drug therapy as it relates to their disability. Only one question regarding ‘my pharmacy staff can adequately answer my questions related to drug therapy and how it may relate to my racial/ethnic background’ showed a significant difference amongst the three cohorts in all of the Likert options (p < 0.045). Table 2 Consumer Perception of Pharmacist and Pharmacy Staff Culturally Competency All Respondents (n = 1218 a ) White, non-Hispanic (n = 200 b ) Ethnically Diverse Without Disability (n = 500 c ) Ethnically Diverse with Disability (n = 518 d ) Median [IQR] I am satisfied with the care the pharmacy staff provide every time I go to the pharmacy 4 [2.0] 4 [1.0] 4 [2.0] 4 [2.0] I consider the pharmacy staff to be knowledgeable about my racial/ethnic background 4 [2.0] 4 [2.0] 4 [2.0] 4 [2.0] I consider the pharmacy staff to be knowledgeable about my disability e ---- --- --- 4 [2.0] My pharmacy staff uses the appropriate language and terms when counseling me about my medications 4 [1.0] 4 [1.0] 4 [2.0] 4 [2.0] My pharmacy staff thinks about my cultures (for example, race, ethnicity, disability) when discussing drug therapy 4 [1.0] 3 [1.0] 4 [1.0] 4 [1.0] My pharmacy staff can adequately answer my questions related to drug therapy and how it may relate to my racial/ethnic background 4 [1.0] 4 [2.0] 4 [1.0] 4 [1.0] My pharmacy staff can adequately answer my questions about my prescriptions and how it relates to my disability e --- ---- ---- 4 [1.0] I am satisfied with the care other personnel (technician, clerks, students) at the pharmacy provide every time I go to the pharmacy 4 [2.0] 4 [1.0] 4 [2.0] 4 [2.0] Likert scale of 1 = Strongly Disagree; 2 = Disagree; 3 = Neither agree or disagree; 4 = Agree; 5 = Strongly Agree; a numbers ranged from 1211–1215 for responses; b numbers ranged from 199–200 for responses; c numbers ranged from 495–500; d numbers ranged from 513–516 for responses; e question was only presented to individuals with disabilities in the survey When asked about their comfort level in discussing their identities, the vast majority of respondents in the control cohort and non-disability cohort felt comfortable discussing their identities as it relates to their medication therapy with the pharmacy staff. Approximately 10% of respondents in non-disability cohort (n = 53/500) stated they did not feel comfortable discussing their needs based on the racial or ethnic background; although, most of the explanations expressed the lack of necessity to bring it up with their pharmacist. Furthermore, several respondents noted that since their pharmacist is not from the same ethnic group or the area has a lack of diversity, the pharmacists may have limited knowledge about other ethnicities. The open-ended questions on barriers and improvements had a small number of relevant responses from the participants (see Table 3 ). The barriers identified were mostly contributed by patients in the disability and non-disability cohorts in which they cited facing prejudice related to their ethnicity, communication and language barriers, and lack of transportation to the pharmacy. Additionally, respondents with a physical disability stated the area within the pharmacy is too small to accommodate the wheelchair, and individuals with hearing loss do not have other non-verbal methods of communication available to them. Suggestions to improve care received within the pharmacy setting included hiring individuals from a diverse background (e.g., able to speak other languages, individuals with disabilities), and diversity and inclusion training which incorporates the needs of people with disabilities. Table 3 Barriers Identified and Suggestions for Improvement Provided by the Respondents (N = 1218) Barriers Related to Race/Ethnicity and/or Disabilities No. Communication and Language barriers 13 Prejudice related to their ethnicity 3 Lack of accommodations for physical disability (e.g., wheelchair, hearing loss) and not knowing how to serve patients with disabilities 4 Lack of transportation to the pharmacy 9 Suggestions for Improvement of Services Hiring individuals from a diverse background (e.g., able to speak other languages, individuals with disabilities) 16 Diversity and inclusion education including needs of people with disabilities 16 Enhance communication methods (e.g. translation services, active listening) 10 Discussion This study provides data on patient experiences interacting with pharmacy staff and their perceptions of interactions based on their cultural background of race, ethnicity, and disability. A consistent finding of the study across all cohorts was that over 50% of respondents were satisfied with care provided to them by the pharmacist and pharmacy staff related to their identities and feel comfortable approaching the pharmacist with questions or needs related to their ethnic background and disability. While these findings show progress toward improving health equity, there are barriers noted by the other respondents in the study that warrant addressing in order to provide the necessary care for patients from all backgrounds who may interact with the pharmacy. Among patients with disabilities, there were numerous barriers identified that pharmacists and pharmacy staff can act on such as increasing the limited waiting space for wheelchairs and improving communication issues with participants who have hearing loss. These barriers align with previous studies reporting individuals with disabilities who experience accessibility and communication issues within the pharmacy [ 25 – 27 ]. It has been recommended pharmacists determine the patient’s sensory status, cognitive abilities, learning style, and physical status prior to any interaction at the pharmacy [ 28 ]. Although, space may be a more difficult component to arrange due to the architecture of the building, the pharmacy staff members should be aware of signage, shelves, and chairs that can be moved to accommodate a larger waiting area for patients with a wheelchair including space around the counseling window. Providing these types of accommodations will demonstrate disability inclusion and may potentially encourage patients to seek health care services including vaccinations in addition to picking up prescriptions. As for communication, several methods are available for pharmacists to use when communicating with patients with hearing loss including a qualified sign language interpreter, oral interpreter, cued-speech interpreter, tactile interpreter, real time captioning, written materials, or printed information. Telecommunication devices such as teletypewriters (TTY) and videophones specifically designed to be used by individuals who have deafness or hearing loss and cannot use a regular telephone. Other assistive technologies include telephone handset amplifiers, hearing aid compatible telephones, text telephones, captioned telephones, and captioning decoders [ 29 ]. Pharmacists can also make sure the prescription labels are written in plain language and important information is written down or visual aids such as posters or videos are provided to explain the content. These methods allow pharmacists to remove communication barriers and minimize medication misuse by ensuring patients fully understand the important components of drug therapy and making available telecommunication devices or other services if patients request these options as their method of communication. Additionally, for individuals who speak a different language, a study noted that cultural factors such as providing written information in Spanish and family involvement in decision-making were important factors for pharmacists to consider when providing care to these patients [ 30 ]. A suggestion provided by the participants in this study to improve the care they receive is to increase the diversity of the pharmacists and staff members in terms of ethnicity, disabilities, and other identities. Based on the 2019 American Community Survey, people from the Black, Hispanic, and Native American backgrounds make up 31% of the US population; however, only 15.7% of PharmD graduates were from the same ethnicity groups in 2019 which indicates underrepresentation of these ethnicities within the pharmacy workforce [ 31 – 33 ]. Within pharmacy practice, strategies to increase the diversity in the workforce include providing scholarship and funding to historically black colleges and universities [ 34 ]. As for individuals with disabilities, there currently is no information on how many pharmacists with disabilities are practicing in pharmacy settings. There is literature focused on providing accommodations to students with disabilities within the PharmD program and recruitment of individuals with disabilities suggesting there is some movement in inclusion of disability within the profession [ 35 – 37 ]. Lastly, another aspect the participants recommended was to provide more training to pharmacists and the pharmacy staff on diversity and inclusion. While cultural intelligence education for pharmacy students in the PharmD curriculum is well known, there is not a standardized curriculum or credit hours noted in accreditation standards and some cultures such as disabilities may be underrepresented or not included in coursework [ 38 ]. Moreover, there is a lack of studies evaluating cultural intelligence training in practicing pharmacists as part of their professional development. There have been suggestions that academic pharmacy institutions and pharmacy professional organizations provide more continuing professional development opportunities to those in pharmacy practice specifically focused on diversity, equity, and inclusion topics [ 39 ]. Additionally, the American Council for Pharmacy Education (ACPE) published guidelines to include diversity, equity, and inclusion in continuing activities for pharmacists and pharmacy technicians to improve their abilities to provide appropriate care to those who are underserved or historically marginalized [ 40 ]. Along those lines, pharmacy licensing boards in Michigan and Illinois have also required implicit bias training for pharmacists [ 41 , 42 ]. These efforts are the impetus to making cultural intelligence an essential component within pharmacy practice allowing for pharmacists to improve care for underserved populations while continuously building knowledge on the evolving aspects of culture. There are several limitations to this study. The participants were given rewards for completion of the survey by Qualtrics which may biased the results by encouraging disinterested participants to fill out the survey quickly. Qualtrics was responsible for recruitment; therefore, a response rate was not calculated as it is unknown how many individuals were contacted, refused to participate, or only answered a few questions on the survey. The sensitive nature of some questions may have caused some participants not to answer questions truthfully or provide incomplete answers. Additionally, the participants were not required to answer all inquiries on the questionnaire including the open text section requiring an explanation or further information to understand their responses (e.g., why do you not feel comfortable discussing ethnicity/disabilities with the pharmacist). This study provides some foundational information and did not dive deeper into the reasoning why patients may feel uncomfortable discussing ethnicity or disability as it relates to the other cultural intelligence domains (awareness, practice, and desire). Response bias may be present as participants who have a positive experience and/or talk to the pharmacist/pharmacy staff once monthly may be more likely to respond to the survey. The survey was not validated due to the exploratory nature of the study. Finally, many of the comments provided by respondents related to improving care based on their racial or ethnic identity or disability status related to pharmacy factors (e.g., hours, location, appearance) that may be out of the control of the individual pharmacy workers. Therefore, the true impact of pharmacist and other employee cultural awareness and engagement may be underestimated due to the outside factors focused on by patients. Conclusion This study provided insight to patient perceptions of care provided by pharmacists and pharmacy staff members at the intersection of race and disability. Patients reported positive experiences related to their race, ethnicity, and disability status when interacting with pharmacists and pharmacy staff members; however, many barriers and other considerations were noted by respondents that when considered could improve their care and experiences at a pharmacy. Further research is required to differentiate pharmacist or pharmacy staff factors from general pharmacy experiences to better understand how individuals may improve their care of patients with diverse backgrounds along with exploring the other cultural intelligence domains. Declarations Conflict of interest statement: The authors do not have any conflicts of interests to declare. Funding: Funding for this study was provided by the University of Kansas Racial Equity Research, Scholarship & Creative Activity Award. Author Contributions: All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by all authors. The first draft of the manuscript was written by Cambrey Nguyen, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgement: Funding for this study was provided by the University of Kansas Racial Equity Research, Scholarship & Creative Activity Award. Data Availability: The survey questions have been included as a supplement. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. References Centers for Disease Control and Prevention. Disability affects us all. Available at: https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html. Accessed 10 Sep 2024. Centers for Disease Control and Prevention. Disability and Health Data System (DHDS). 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Res Social Adm Pharm . 2022;18(5):2711-2713. https://doi:10.1016/j.sapharm.2022.01.009 Dagnachew N, Meshesha SG, Mekonen ZT. A qualitative exploration of barriers in accessing community pharmacy services for persons with disability in Addis Ababa, Ethiopia: a cross sectional phenomenological study. BMC Health Serv Res . 2021 Dec; 21(1):1–8. ASHP guidelines on pharmacist-conducted patient education and counseling. Am J Health Syst Pharm . 1997;54: 431–434. https://doi:10.1093/ajhp/54.4.431 U.S. Department of Justice and Civil Rights Division. ADA Requirements: Effective Communication. Updated February 28, 2020. Available at: https://www.ada.gov/resources/effective-communication/. Accessed March 11, 2024. Kim-Romo DN, Barner JC, Brown CM, et al. Spanish-speaking patients’ satisfaction with clinical pharmacists’ communication skills and demonstration of cultural sensitivity. J Am Pharm Assoc (2003) . 2014;54(2):121-129. https://doi:10.1331/JAPhA.2014.13090 American Association of Colleges of Pharmacy graduating student survey 2023 national summary report; 2023. 〈https://www.aacp.org/sites/default/files/2023-08/2023-gss-national-summary-report.pdf〉. Accessed 29 Aug 2024. United States Census Bureau. American Community Survey Data Tables. Available at: https://www.census.gov/programs-surveys/acs/data/data-tables.html. Accessed 29 Aug 2024. George A, Teelucksingh K, Fortune K. Diversity, equity, and inclusion in the profession of pharmacy: The perspective of three pharmacy leaders. HCA Healthc J Med . 2023;4(2):77-82. Published 2023 Apr 28. https://doi:10.36518/2689-0216.1561 Moultry AM. The evolving role of historically black pharmacy schools in a changing environment. Am J Pharm Educ. 2021;85(9):8589. https://doi:10.5688/ajpe8589. Soucie J, Roland B, Parsons S, Cavanaugh TM. A Call to embrace disability in pharmacy education. Am J Pharm Educ . 2024;88(2):100643. https://doi:10.1016/j.ajpe.2024.100643 Kieser M, Feudo D, Legg J, et al. Accommodating pharmacy students with physical disabilities during the experiential learning curricula. Am J Pharm Educ . 2022;86(1):8426. https://doi:10.5688/ajpe8426 Hussain FN, Smith A, Wilby KJ. The visibility of disabilities within pharmacy program recruitment material. Innov Pharm . 2020;11(3):10.24926/iip.v11i3.3339. Published 2020 Jul 31. https://doi:10.24926/iip.v11i3.3339 Smith WT, Roth JJ, Okoro O, Kimberlin C, Odedina FT. Disability in cultural competency pharmacy education. Am J Pharm Educ . 2011;75(2):26. https://doi:10.5688/ajpe75226 Arif SA, Butler LM, Gettig JP, et al. Taking action towards equity, diversity, and inclusion in the pharmacy curriculum and continuing professional development. Am J Pharm Educ . 2023;87(2):ajpe8902. https://doi:10.5688/ajpe8902 Accreditation Council for Pharmacy Education. ACPE Guidance to ACPE-Accredited CE Providers to Incorporate Diversity, Equity and Inclusion in CE Activities. 2021:2. http://www.acpe-accredit.org/pdf/ACPE_CE_Guidance_Diversity_Equity_Inclusion_Jan_2021_Final.pdf. Accessed 29 Aug 2024. Nicholas M. Implicit Bias: Recognizing and Responding in Healthcare Settings. Illinois Physical Therapy Association. Published 2023. https://www.ipta.org/store/viewproduct.aspx?id=21540108. Accessed 29 Aug 2024. Bureau of Professional Licensing. Bureau of Professional Licensing, FAQs for Implicit Bias Training. Published online 2021:3. https://www.michigan.gov/documents/lara/Implicit_Bias_FAQs_FINAL_7.22.2021_731300_7.pdf. Accessed 29 Aug 2024. Supplementary Files Supplement1SurveyQuestions.docx Cite Share Download PDF Status: Published Journal Publication published 15 Apr, 2025 Read the published version in International Journal of Clinical Pharmacy → Version 1 posted Editorial decision: Major revisions 08 Jan, 2025 Reviewers agreed at journal 05 Nov, 2024 Reviewers invited by journal 25 Oct, 2024 Editor invited by journal 25 Oct, 2024 Editor assigned by journal 25 Oct, 2024 First submitted to journal 24 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5314061","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":370549269,"identity":"b7f18a57-0c7d-49f6-bf7c-ee10facb64e9","order_by":0,"name":"Cambrey B Nguyen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIiWNgGAWjYHACNmSODYzLTLSWNNK1HIYxcGvhbz+d9rii4jCDOf8aM4mPO84n9rH3GH5gqLBObMChReJM7nbDM2cOM1jOeGMmOfPM7cQ2njPGEgxn0nFqMWDI3SbZ2Ha4fsONM2bSvG1ALRK5GyQY2w7j1sL/Fqjl32EGA5CWv23nQFo2/2D8h0eLBMiWBqCW8z1m0oxtB0BatkkwNuDWInHj7XbDhmPpQFvYii1725KN23jOf7NIOJZujEsLf3/utocNNdZAWw5vvPGzzU52fntb8o0PNdayuLRAQTPQvgQWCTg/Ab9yEKgD2neA+QNhhaNgFIyCUTASAQC+SV65LXifzwAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-0140-4173","institution":"UI College of Pharmacy: The University of Iowa College of Pharmacy","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Cambrey","middleName":"B","lastName":"Nguyen","suffix":""},{"id":370549270,"identity":"7490d400-f3ec-462a-81e1-75502d581bc7","order_by":1,"name":"Brittany Melton","email":"","orcid":"","institution":"The University of Kansas - Lawrence Campus: The University of Kansas","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Brittany","middleName":"","lastName":"Melton","suffix":""},{"id":370549271,"identity":"51f5c111-3ed8-48fe-b35b-e69b113313d1","order_by":2,"name":"Kristin Villa","email":"","orcid":"","institution":"University of Missouri-Kansas City School of Pharmacy","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kristin","middleName":"","lastName":"Villa","suffix":""}],"badges":[],"createdAt":"2024-10-22 19:20:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5314061/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5314061/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11096-025-01911-5","type":"published","date":"2025-04-15T15:57:37+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":81050970,"identity":"a02a0cda-ff35-4c86-892a-34f137600c26","added_by":"auto","created_at":"2025-04-21 16:09:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":705214,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5314061/v1/c1f18fc8-7a88-4017-9fa5-df57d8e7e84a.pdf"},{"id":68324655,"identity":"2c95c9ca-a5be-4a32-97d4-97451f4cc1b7","added_by":"auto","created_at":"2024-11-06 05:39:44","extension":"docx","order_by":9,"title":"","display":"","copyAsset":false,"role":"supplement","size":21038,"visible":true,"origin":"","legend":"","description":"","filename":"Supplement1SurveyQuestions.docx","url":"https://assets-eu.researchsquare.com/files/rs-5314061/v1/bbdc3d66bc8681e2470fdbb5.docx"}],"financialInterests":"","formattedTitle":"A Cross-Sectional Online Survey: Exploring the patient perspective of community pharmacies delivering care to ethnically diverse individuals with disabilities","fulltext":[{"header":"Impact Statements","content":"\u003cul\u003e\n \u003cli\u003eThis study contributes to the limited research on patient experiences interacting with pharmacy staff and their perceptions of interactions based on their cultural background of race, ethnicity, and disability.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cul\u003e\n \u003cli\u003ePatients with disabilities identified barriers including a lack of physical accommodations and non-verbal communication methods available at the pharmacy.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eIncreasing professional development in cultural intelligence will help pharmacists understand the needs of patients from different cultural backgrounds including those with disabilities along with hiring more diverse staff members.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eThe Centers for Disease Control and Prevention (CDC) cites over one in four people live with a disability in the United States [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. A disability may impact individuals of all ages and racial or ethnic backgrounds, and the subgroup with the highest prevalence of disability among adults over the 18 years of age were American Indian and Alaskan Native at 38.7% based on 2022 data [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Healthy People 2020 reported adults with disabilities encounter barriers that prevent access to available healthcare and other services pertaining to wellness [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Moreover, people with disabilities are more likely to have arthritis, diabetes, and a heart attack along with having unmet medical, dental, and prescription needs compared to those who do not have a disability with these disparities being greater if the individual has a disability and from an ethnically diverse background [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo reduce inequities in healthcare, providers have been encouraged to deliver patient-centered and culturally responsive care through practices which incorporate the patients\u0026rsquo; social, cultural, and linguistic needs [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This concept was acknowledged in the early 2000s from studies that noted patients of diverse backgrounds, specifically racial and ethnic minorities, received lower quality healthcare and poorer health outcomes when compared to non-minority patients due to system and provider biases [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Cultural competency has been a standard in health education, provider practice, and health system goals to improve equity for individuals from diverse cultural backgrounds (race, age, and disabilities) leading to better patient health outcomes [\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Despite emphasizing cultural competence and integrating these practices into patient care, healthcare professionals have found difficulty incorporating patient traits with culturally competent care and understanding systemic practices including implicit biases [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In a two phase study evaluated cross-cultural competency of providers in a primary care clinic as perceived by patients of Asian descent with diabetes, and the results showed the cultural competency of providers was inadequate with a significant negative correlation for the providers\u0026rsquo; cultural competency score, and the patient\u0026rsquo;s HbA1C levels [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Another challenge noted in the literature is the feasibility of healthcare professionals to obtain and fully understand the spectrum of every culture due to complexities associated with a culture; therefore, the concept of cultural intelligence domains emerged to encourage not only knowledge but awareness, practice, and desire when providing patient-centered care [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough culturally competent care has been shown to be inadequate in medicine, failure to provide culturally intelligent care by pharmacists may have detrimental impact as patients more often visit community pharmacies than other healthcare professionals [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Additionally, pharmacy programs routinely provide instruction on culture and biases aimed to improve care; however, these discussions are often focused on cultural differences of race or ethnicity. Other cultural differences, including disability culture, are often underrepresented in discussions throughout education programs [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Due to the number of contacts and the underrepresentation of certain cultures in educational programs, the cultural intelligence of pharmacists can significantly impact patient health equity, especially at the intersection of race and disability.\u003c/p\u003e \u003cp\u003eThe literature in the area of evaluating culturally-responsive care of pharmacists and pharmacies to patients is currently limited [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. A pilot found the community pharmacists\u0026rsquo; attitude was relatively positive toward cultural awareness and sensitivity; however, another study revealed that pharmacists did not have a good understanding of hearing disabilities and deaf culture [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. A recent qualitative study conducted in the UK obtained perspectives of 14 community pharmacy staff members on cultural competency training, and the results showed these individuals recognize there is a need for an inclusive approach to assist patients from different ethnicities by understanding the cultural beliefs that may influence drug therapy, and educating the pharmacy profession in cultural competency within the pharmacy school curriculum [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAim\u003c/strong\u003e \u003cp\u003eWhile there is evidence that pharmacist cultural intelligence can impact patient care, there are few studies exploring patient perceptions of cultural interactions, cultural interactions across multiple groups, and interactions at the intersection of race and disability. This study aims to explore the intersectionality of race and disabilities and patient perception of care provided by pharmacists and other pharmacy staff members.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthics Approval:\u003c/strong\u003e \u003cp\u003eUniversity of Kansas Human Research Protection Program provided approval on July 31, 2024 (ID: STUDY00151493).\u003c/p\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study was a prospective, cross-sectional, questionnaire using a convenience sample of consumers across the United States. Informed consent was obtained from all individual participants included in the study. Consumers were eligible for this study if they are at least 18 years old, can read and understand English, and can access the survey questions using an electronic device. Additional qualifiers for the study included going to a pharmacy to obtain prescription medications and interacting with the pharmacy staff (e.g., pharmacist, technicians) during the visit. The target responses were at least 1200 and participants were assigned to one of three groups depending on how they self-identified, with white, non-Hispanic participants without a disability serving as the control group and other participants were ethnically/racially diverse and grouped on the presence or absence of a disability. Qualtrics was the online survey provider for the study and was responsible for participant recruitment, survey administration, and data delivery. The survey consisted of demographic information (e.g., age, gender, and race), frequency of interactions with the pharmacy staff, and perception of culturally responsive care delivered by pharmacists and pharmacy staff using a set of Likert scale questions (1\u0026thinsp;=\u0026thinsp;strongly disagree, 5\u0026thinsp;=\u0026thinsp;strongly agree). Other questions focused on barriers related to ethnicity and/or disability status as an impact factor on obtaining medications in the community setting and suggestions on how to improve services provided by the pharmacy related to the patient\u0026rsquo;s culture of ethnicity and disability. Participants identifying as both ethnically diverse and having a disability received an additional question pertaining to the care they receive as it relates to their disability status. The questions consisted of multiple-choice, yes or no, and text-entry (open-ended) questions. The total number of questions presented to participants depended on their demographic response (e.g., those with disabilities were presented with two additional Likert questions).\u003c/p\u003e \u003cp\u003eDemographic information was reported using descriptive statistics (mean) and the Likert portion of the survey was reported using median/IQR using SPSS v. 27. The Pearson\u0026rsquo;s Chi-Square test was used to determine statistical significance of gender distribution, and the Kruskal-Wallis test was used to compare Likert scale ratings along with frequency of interactions with the pharmacist and pharmacy staff among the three cohorts. The level of statistical significance was set at α\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for all analyses. Qualtrics provided respondents with incentives based on a point system and respondents may redeem their points for awards in the form of gift cards, airline credit, online game credit, etc.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 1218 people completed the anonymous, nationwide, online survey administered through Qualtrics (Provo, UT) from August 7 to August 14, 2024. and the demographics are provided in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Overall, the median age was 41 years and 66% of respondents were female. The distribution of age was statistically significant amongst the control group of white, non-Hispanic without disabilities (n\u0026thinsp;=\u0026thinsp;200), ethnically diverse without disabilities (n\u0026thinsp;=\u0026thinsp;500, [non-disability cohort]), and ethnically diverse with disabilities (n\u0026thinsp;=\u0026thinsp;518, [disability cohort]) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001); however, gender was not found to be statistically significant. In the disability and non-disability cohorts (n\u0026thinsp;=\u0026thinsp;1018), most of the respondents self-reported as Black or African-American and approximately 10% of the respondents had multiple disabilities. Over half of the respondents earned a high school diploma or GED and attended some college with an annual income of less than \u003cspan\u003e$\u003c/span\u003e50,000. The regional geographic representation of the respondents included 20.9% from the Midwest, 17.2% from the northeast, 38.1% from the south, and 23.8% from the west. These percentages were based on the general population as gathered by the census to reflect the percentage of census respondents that live in each region. In the overall population, 47% of participants interact with the employees in the pharmacy and ask pharmacists about their medications on a monthly basis. Less than 17% of participants have interactions with their pharmacy team or speak to a pharmacist weekly. There was a significantly more participants in the disability cohort that talked to pharmacist and staff on a monthly basis compared to the other two cohorts (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics of Survey Respondents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll Respondents\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhite, non-Hispanic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEthnically Diverse Without Disability\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEthnically Diverse with Disability\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (median, IQR) n\u0026thinsp;=\u0026thinsp;1213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 [31\u0026ndash;51]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 [38\u0026ndash;65]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 [29\u0026ndash;45]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41 [31\u0026ndash;53]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;1218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;518\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e807 (66.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141 (70.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e331 (66.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e335 (64.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;1218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;518\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite, non-Hispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e200 (16.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200 (16.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79 (6.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (11.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24 (4.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic, Latinx\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e154 (12.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76 (15.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78 (15.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack or African American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e668 (54.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e328 (65.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e340 (65.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNative Hawaiian or Pacific Islander\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAmerican Indian or Alaska Native\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (5.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (5.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37 (7.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (3.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (2.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of Disability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;1218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;518\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo disability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e700 (57.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e200 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e500 (100%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeafness or Hard of Hearing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (2.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32 (6.17%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow vision or Visually Impaired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e106 (8.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e106 (20.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMotor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e82 (15.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognitive or Learning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (4.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118 (9.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e118 (22.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e125 (10.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e125 (24.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation Status (highest degree)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;1218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;518\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than high school degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69 (5.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (4.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (4.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39 (7.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh School graduate or GED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e409 (33.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (27.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e181 (36.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e173 (33.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSome college\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e419 (34.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 (38.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e160 (32.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e182 (35.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e198 (16.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84 (16.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaster\u0026rsquo;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (6.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (8.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (7.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (2.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (2.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (1.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (1.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (1.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnnual Household Income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;1218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;518\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u003cspan\u003e$\u003c/span\u003e25,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e397 (32.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (27.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e134 (26.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e209 (40.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e25,000-\u003cspan\u003e$\u003c/span\u003e34,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e219 (18.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (14.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98 (19.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e92 (17.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e35,000-\u003cspan\u003e$\u003c/span\u003e49,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e176 (14.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (19.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e61 (11.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e50,000-\u003cspan\u003e$\u003c/span\u003e74,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e207 (17.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86 (17.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e81 (15.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e75,000-\u003cspan\u003e$\u003c/span\u003e99,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (10.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (12.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan\u003e$\u003c/span\u003e100,000-\u003cspan\u003e$\u003c/span\u003e149,999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69 (5.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (6.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (5.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27 (5.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u003cspan\u003e$\u003c/span\u003e150,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (2.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (3.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe perceptions of pharmacy care based on a Likert scale are reported in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Overall, over 50% of respondents were satisfied with the quality of care provided by pharmacists and pharmacy staff based on the individual Likert items. Patients with disabilities also agreed the pharmacy staff is knowledgeable and can answer questions about drug therapy as it relates to their disability. Only one question regarding \u0026lsquo;my pharmacy staff can adequately answer my questions related to drug therapy and how it may relate to my racial/ethnic background\u0026rsquo; showed a significant difference amongst the three cohorts in all of the Likert options (p\u0026thinsp;\u0026lt;\u0026thinsp;0.045).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eConsumer Perception of Pharmacist and Pharmacy Staff Culturally Competency\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll Respondents (n\u0026thinsp;=\u0026thinsp;1218\u003csup\u003ea\u003c/sup\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWhite, non-Hispanic\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;200\u003csup\u003eb\u003c/sup\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEthnically Diverse Without Disability (n\u0026thinsp;=\u0026thinsp;500\u003csup\u003ec\u003c/sup\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEthnically Diverse with Disability\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;518\u003csup\u003ed\u003c/sup\u003e)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eMedian [IQR]\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am satisfied with the care the pharmacy staff provide every time I go to the pharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 [2.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 [1.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 [2.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 [2.0]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI consider the pharmacy staff to be knowledgeable about my racial/ethnic background\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 [2.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 [2.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 [2.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 [2.0]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI consider the pharmacy staff to be knowledgeable about my disability\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 [2.0]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy pharmacy staff uses the appropriate language and terms when counseling me about my medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 [1.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 [1.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 [2.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 [2.0]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy pharmacy staff thinks about my cultures (for example, race, ethnicity, disability) when discussing drug therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 [1.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 [1.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 [1.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 [1.0]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy pharmacy staff can adequately answer my questions related to drug therapy and how it may relate to my racial/ethnic background\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 [1.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 [2.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 [1.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 [1.0]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMy pharmacy staff can adequately answer my questions about my prescriptions and how it relates to my disability\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e----\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e----\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 [1.0]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI am satisfied with the care other personnel (technician, clerks, students) at the pharmacy provide every time I go to the pharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 [2.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 [1.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 [2.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4 [2.0]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eLikert scale of 1\u0026thinsp;=\u0026thinsp;Strongly Disagree; 2\u0026thinsp;=\u0026thinsp;Disagree; 3\u0026thinsp;=\u0026thinsp;Neither agree or disagree; 4\u0026thinsp;=\u0026thinsp;Agree; 5\u0026thinsp;=\u0026thinsp;Strongly Agree; \u003csup\u003ea\u003c/sup\u003enumbers ranged from 1211\u0026ndash;1215 for responses; \u003csup\u003eb\u003c/sup\u003enumbers ranged from 199\u0026ndash;200 for responses; \u003csup\u003ec\u003c/sup\u003enumbers ranged from 495\u0026ndash;500; \u003csup\u003ed\u003c/sup\u003e numbers ranged from 513\u0026ndash;516 for responses; \u003csup\u003ee\u003c/sup\u003equestion was only presented to individuals with disabilities in the survey\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen asked about their comfort level in discussing their identities, the vast majority of respondents in the control cohort and non-disability cohort felt comfortable discussing their identities as it relates to their medication therapy with the pharmacy staff. Approximately 10% of respondents in non-disability cohort (n\u0026thinsp;=\u0026thinsp;53/500) stated they did not feel comfortable discussing their needs based on the racial or ethnic background; although, most of the explanations expressed the lack of necessity to bring it up with their pharmacist. Furthermore, several respondents noted that since their pharmacist is not from the same ethnic group or the area has a lack of diversity, the pharmacists may have limited knowledge about other ethnicities.\u003c/p\u003e \u003cp\u003eThe open-ended questions on barriers and improvements had a small number of relevant responses from the participants (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The barriers identified were mostly contributed by patients in the disability and non-disability cohorts in which they cited facing prejudice related to their ethnicity, communication and language barriers, and lack of transportation to the pharmacy. Additionally, respondents with a physical disability stated the area within the pharmacy is too small to accommodate the wheelchair, and individuals with hearing loss do not have other non-verbal methods of communication available to them. Suggestions to improve care received within the pharmacy setting included hiring individuals from a diverse background (e.g., able to speak other languages, individuals with disabilities), and diversity and inclusion training which incorporates the needs of people with disabilities.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBarriers Identified and Suggestions for Improvement Provided by the Respondents (N\u0026thinsp;=\u0026thinsp;1218)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBarriers Related to Race/Ethnicity and/or Disabilities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunication and Language barriers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrejudice related to their ethnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of accommodations for physical disability (e.g., wheelchair, hearing loss) and not knowing how to serve patients with disabilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of transportation to the pharmacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSuggestions for Improvement of Services\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHiring individuals from a diverse background (e.g., able to speak other languages, individuals with disabilities)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiversity and inclusion education including needs of people with disabilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnhance communication methods (e.g. translation services, active listening)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides data on patient experiences interacting with pharmacy staff and their perceptions of interactions based on their cultural background of race, ethnicity, and disability. A consistent finding of the study across all cohorts was that over 50% of respondents were satisfied with care provided to them by the pharmacist and pharmacy staff related to their identities and feel comfortable approaching the pharmacist with questions or needs related to their ethnic background and disability. While these findings show progress toward improving health equity, there are barriers noted by the other respondents in the study that warrant addressing in order to provide the necessary care for patients from all backgrounds who may interact with the pharmacy.\u003c/p\u003e \u003cp\u003eAmong patients with disabilities, there were numerous barriers identified that pharmacists and pharmacy staff can act on such as increasing the limited waiting space for wheelchairs and improving communication issues with participants who have hearing loss. These barriers align with previous studies reporting individuals with disabilities who experience accessibility and communication issues within the pharmacy [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. It has been recommended pharmacists determine the patient\u0026rsquo;s sensory status, cognitive abilities, learning style, and physical status prior to any interaction at the pharmacy [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Although, space may be a more difficult component to arrange due to the architecture of the building, the pharmacy staff members should be aware of signage, shelves, and chairs that can be moved to accommodate a larger waiting area for patients with a wheelchair including space around the counseling window. Providing these types of accommodations will demonstrate disability inclusion and may potentially encourage patients to seek health care services including vaccinations in addition to picking up prescriptions. As for communication, several methods are available for pharmacists to use when communicating with patients with hearing loss including a qualified sign language interpreter, oral interpreter, cued-speech interpreter, tactile interpreter, real time captioning, written materials, or printed information. Telecommunication devices such as teletypewriters (TTY) and videophones specifically designed to be used by individuals who have deafness or hearing loss and cannot use a regular telephone. Other assistive technologies include telephone handset amplifiers, hearing aid compatible telephones, text telephones, captioned telephones, and captioning decoders [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Pharmacists can also make sure the prescription labels are written in plain language and important information is written down or visual aids such as posters or videos are provided to explain the content. These methods allow pharmacists to remove communication barriers and minimize medication misuse by ensuring patients fully understand the important components of drug therapy and making available telecommunication devices or other services if patients request these options as their method of communication. Additionally, for individuals who speak a different language, a study noted that cultural factors such as providing written information in Spanish and family involvement in decision-making were important factors for pharmacists to consider when providing care to these patients [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA suggestion provided by the participants in this study to improve the care they receive is to increase the diversity of the pharmacists and staff members in terms of ethnicity, disabilities, and other identities. Based on the 2019 American Community Survey, people from the Black, Hispanic, and Native American backgrounds make up 31% of the US population; however, only 15.7% of PharmD graduates were from the same ethnicity groups in 2019 which indicates underrepresentation of these ethnicities within the pharmacy workforce [\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Within pharmacy practice, strategies to increase the diversity in the workforce include providing scholarship and funding to historically black colleges and universities [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. As for individuals with disabilities, there currently is no information on how many pharmacists with disabilities are practicing in pharmacy settings. There is literature focused on providing accommodations to students with disabilities within the PharmD program and recruitment of individuals with disabilities suggesting there is some movement in inclusion of disability within the profession [\u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLastly, another aspect the participants recommended was to provide more training to pharmacists and the pharmacy staff on diversity and inclusion. While cultural intelligence education for pharmacy students in the PharmD curriculum is well known, there is not a standardized curriculum or credit hours noted in accreditation standards and some cultures such as disabilities may be underrepresented or not included in coursework [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Moreover, there is a lack of studies evaluating cultural intelligence training in practicing pharmacists as part of their professional development. There have been suggestions that academic pharmacy institutions and pharmacy professional organizations provide more continuing professional development opportunities to those in pharmacy practice specifically focused on diversity, equity, and inclusion topics [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Additionally, the American Council for Pharmacy Education (ACPE) published guidelines to include diversity, equity, and inclusion in continuing activities for pharmacists and pharmacy technicians to improve their abilities to provide appropriate care to those who are underserved or historically marginalized [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Along those lines, pharmacy licensing boards in Michigan and Illinois have also required implicit bias training for pharmacists [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. These efforts are the impetus to making cultural intelligence an essential component within pharmacy practice allowing for pharmacists to improve care for underserved populations while continuously building knowledge on the evolving aspects of culture.\u003c/p\u003e \u003cp\u003eThere are several limitations to this study. The participants were given rewards for completion of the survey by Qualtrics which may biased the results by encouraging disinterested participants to fill out the survey quickly. Qualtrics was responsible for recruitment; therefore, a response rate was not calculated as it is unknown how many individuals were contacted, refused to participate, or only answered a few questions on the survey. The sensitive nature of some questions may have caused some participants not to answer questions truthfully or provide incomplete answers. Additionally, the participants were not required to answer all inquiries on the questionnaire including the open text section requiring an explanation or further information to understand their responses (e.g., why do you not feel comfortable discussing ethnicity/disabilities with the pharmacist). This study provides some foundational information and did not dive deeper into the reasoning why patients may feel uncomfortable discussing ethnicity or disability as it relates to the other cultural intelligence domains (awareness, practice, and desire). Response bias may be present as participants who have a positive experience and/or talk to the pharmacist/pharmacy staff once monthly may be more likely to respond to the survey. The survey was not validated due to the exploratory nature of the study. Finally, many of the comments provided by respondents related to improving care based on their racial or ethnic identity or disability status related to pharmacy factors (e.g., hours, location, appearance) that may be out of the control of the individual pharmacy workers. Therefore, the true impact of pharmacist and other employee cultural awareness and engagement may be underestimated due to the outside factors focused on by patients.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provided insight to patient perceptions of care provided by pharmacists and pharmacy staff members at the intersection of race and disability. Patients reported positive experiences related to their race, ethnicity, and disability status when interacting with pharmacists and pharmacy staff members; however, many barriers and other considerations were noted by respondents that when considered could improve their care and experiences at a pharmacy. Further research is required to differentiate pharmacist or pharmacy staff factors from general pharmacy experiences to better understand how individuals may improve their care of patients with diverse backgrounds along with exploring the other cultural intelligence domains.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflict of interest statement:\u003c/h2\u003e \u003cp\u003eThe authors do not have any conflicts of interests to declare.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eFunding for this study was provided by the University of Kansas Racial Equity Research, Scholarship \u0026amp; Creative Activity Award.\u003c/p\u003e\u003ch2\u003eAuthor Contributions:\u003c/h2\u003e \u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by all authors. The first draft of the manuscript was written by Cambrey Nguyen, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement:\u003c/h2\u003e \u003cp\u003eFunding for this study was provided by the University of Kansas Racial Equity Research, Scholarship \u0026amp; Creative Activity Award.\u003c/p\u003e\u003ch2\u003eData Availability:\u003c/h2\u003e \u003cp\u003eThe survey questions have been included as a supplement. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCenters for Disease Control and Prevention. Disability affects us all. Available at: https://www.cdc.gov/ncbddd/disabilityandhealth/infographic-disability-impacts-all.html. 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Taking action towards equity, diversity, and inclusion in the pharmacy curriculum and continuing professional development. \u003cem\u003eAm J Pharm Educ\u003c/em\u003e. 2023;87(2):ajpe8902. https://doi:10.5688/ajpe8902\u003c/li\u003e\n\u003cli\u003eAccreditation Council for Pharmacy Education. ACPE Guidance to ACPE-Accredited CE Providers to Incorporate Diversity, Equity and Inclusion in CE Activities. 2021:2. http://www.acpe-accredit.org/pdf/ACPE_CE_Guidance_Diversity_Equity_Inclusion_Jan_2021_Final.pdf. Accessed 29 Aug 2024.\u003c/li\u003e\n\u003cli\u003eNicholas M. Implicit Bias: Recognizing and Responding in Healthcare Settings. Illinois Physical Therapy Association. Published 2023. https://www.ipta.org/store/viewproduct.aspx?id=21540108. Accessed 29 Aug 2024.\u003c/li\u003e\n\u003cli\u003eBureau of Professional Licensing. Bureau of Professional Licensing, FAQs for Implicit Bias Training. 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Accessed 29 Aug 2024.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-clinical-pharmacy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijcp","sideBox":"Learn more about [International Journal of Clinical Pharmacy](https://www.springer.com/journal/11096)","snPcode":"11096","submissionUrl":"https://submission.nature.com/new-submission/11096/3","title":"International Journal of Clinical Pharmacy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-5314061/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5314061/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAccording to the Centers for Disease Control and Prevention (CDC), more than one in four people live with a disability in the US, and 76.8% of adults with disabilities encounter barriers that prevent access to available healthcare. To reduce inequities, healthcare professionals are encouraged to provide patient-centered and culturally responsive care.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThis study was a prospective, cross-sectional, questionnaire-based study that obtained patient perception of community pharmacies providing culturally responsive care to ethnically diverse patients with disabilities.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eRespondents were recruited by Qualtrics to complete an anonymous, nationwide, online survey from August 7 to August 14, 2024. The survey asked for demographic information, frequency of encounters with the pharmacy, perception of quality of care based on their identities (ethnicity, disability), barriers in obtaining medications, and suggestions to improve services. Demographics were reported using descriptive statistics and the Kruskal-Wallis test was used to compare Likert scale responses.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 1218 respondents completed the survey; 200 self-identified as white, non-Hispanic without disabilities which served as the control and 1018 patients were from an ethnically diverse background with a disability (n\u0026thinsp;=\u0026thinsp;518) or without disabilities (n\u0026thinsp;=\u0026thinsp;500). Overall, the median age was 41 years and 66% of respondents were female. In all of the cohorts, over 50% of respondents were satisfied with the quality of care provided by pharmacists and pharmacy staff. Barriers identified were communication issues (specific to hearing) and the limited physical space for patients in wheelchairs. Patients suggested increased diversity of staff members in the pharmacy along with training for pharmacists and staff on the needs of those with disabilities.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePatients reported positive experiences related to their race, ethnicity, and disability status when interacting with the pharmacy; however, many barriers and other considerations were noted by respondents that may improve their care and experiences.\u003c/p\u003e","manuscriptTitle":"A Cross-Sectional Online Survey: Exploring the patient perspective of community pharmacies delivering care to ethnically diverse individuals with disabilities","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-06 05:39:40","doi":"10.21203/rs.3.rs-5314061/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revisions","date":"2025-01-08T17:40:21+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2024-11-05T22:49:50+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-10-25T21:02:33+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"International Journal of Clinical Pharmacy","date":"2024-10-25T15:37:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-25T12:49:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Clinical Pharmacy","date":"2024-10-24T09:36:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-clinical-pharmacy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijcp","sideBox":"Learn more about [International Journal of Clinical Pharmacy](https://www.springer.com/journal/11096)","snPcode":"11096","submissionUrl":"https://submission.nature.com/new-submission/11096/3","title":"International Journal of Clinical Pharmacy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"2d78d695-37da-4d5f-bd63-0b4c6b2d4384","owner":[],"postedDate":"November 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-21T16:03:51+00:00","versionOfRecord":{"articleIdentity":"rs-5314061","link":"https://doi.org/10.1007/s11096-025-01911-5","journal":{"identity":"international-journal-of-clinical-pharmacy","isVorOnly":false,"title":"International Journal of Clinical Pharmacy"},"publishedOn":"2025-04-15 15:57:37","publishedOnDateReadable":"April 15th, 2025"},"versionCreatedAt":"2024-11-06 05:39:40","video":"","vorDoi":"10.1007/s11096-025-01911-5","vorDoiUrl":"https://doi.org/10.1007/s11096-025-01911-5","workflowStages":[]},"version":"v1","identity":"rs-5314061","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5314061","identity":"rs-5314061","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}