title: Cultural barriers encountered by Norwegian community pharmacists in providing service to non-Western immigrant patients.
abstract: BACKGROUND
  Western societies' need for knowledge about how to meet the challenges in health care following increased immigration has emerged as studies have showed that non-Western immigrants tend to experience more obstacles to drug use and poorer communication with health professionals.
  
  
  OBJECTIVE
  To identify the cultural barriers encountered by Norwegian community pharmacists in providing service to non-Western immigrant patients and to outline how they are being addressed.
  
  
  METHODS
  Community pharmacies in Oslo, Norway.
  
  
  METHODS
  A qualitative study consisting of four focus groups was conducted. In total 19 ethnic Norwegian pharmacists (17 female and 2 male; mean age: 40.6 years) participated. They were recruited from 13 pharmacies situated in areas of Oslo densely populated by non-Western immigrants. The audio-records of the focus group discussions were transcribed verbatim. A thematic content analysis was conducted. Main outcome measure Cultural barriers identified by Norwegian community pharmacists in the encounter with non-Western immigrants.
  
  
  RESULTS
  All the pharmacists were in contact with non-Western immigrant patients on a daily basis. They said that they found it challenging to provide adequate service to these patients, and that the presence of language as well as other cultural barriers not only affected what the patients got out of the available information, but also to a great extent what kind of and how much information was provided. Although the pharmacists felt that immigrant patients were in great need of drug counselling, there were large disparities in how much effort was exerted in order to provide this service. They were all uncomfortable with situations where family or friends acted as interpreters, especially children. Otherwise, cultural barriers were related to differences in body language and clothing which they thought distracted the communication. All the pharmacists stated that they had patients asking about the content of pork gelatin in medicines, but few said that they habitually notified the patients of this unless they were asked directly. Ramadan fasting was not identified as a subject during drug counselling.
  
  
  CONCLUSIONS
  This focus group study shows that language and other cultural barriers, including differences in body language, non-Western gender roles, and all-covering garments, are of great concern for ethnic Norwegian community pharmacists in the encounter with non-Western immigrant patients. Although the pharmacists recognise their role as drug information providers for immigrant patients, large disparities were detected with respect to kind of and amount of information provided to these patients.
authors.affiliation: Department of Social Pharmacy, School of Pharmacy, University of Oslo, Blindern, P.O. Box 1068, 0316, Oslo, Norway, helle.hakonsen@farmasi.uio.no.
authors.forename: Helle
authors.initials: H
authors.lastname: Håkonsen
authors.forename: Karine
authors.initials: K
authors.lastname: Lees
authors.forename: Else-Lydia
authors.initials: EL
authors.lastname: Toverud
mesh_terms: D000328:Adult; D000368:Aged; D065246:Culturally Competent Care / Q000208:ethnology* / Q000379:methods; D054242:Emigrants and Immigrants; D005260:Female; D017144:Focus Groups / Q000379:methods; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000208:ethnology; D010594:Pharmacies; D010595:Pharmacists