Experiences, Challenges, and Practices of Visually Impaired Patients and Pharmacists Within the South African Pharmacy Healthcare System

Abstract

Vision loss amongst individuals who are visually impaired, or blind (VIB) has a huge impact on their experiences at pharmacies and the quality of healthcare they receive. Visual impairment/blindness adds new complexities to health seeking and health management behaviours. Pharmacists play a key role in fulfilling the health needs of VIB patients. The experiences and challenges VIB patients face from a pharmaceutical healthcare perspective are unique and worth understanding. Despite this, within the South African context, research exploring the experiences, challenges and current state of pharmacy healthcare toward VIB individuals is limited. Aim: The aim of the study was to explore the challenges experiences and current practices implemented by pharmacists in meeting the pharmacy healthcare needs of VIB individuals in South Africa. Method: This study utilised a convergent parallel mixed method approach that enabled the collection of quantitative and qualitative data simultaneously. A three-phased approach was applied, with phase 1 surveying pharmacists in South Africa; phase 2 interviewing 12 VIB individuals and 12 pharmacists; and phase 3 consisting of the integration of phases 1 and 2, where the quantitative and qualitative data was consolidated to help provide insights on the research questions. Questionnaires were developed and distributed online using REDcap® to pharmacists. Survey data was analysed using descriptive statistics and presented in the form of frequencies, means, figures and graphs. Pearson chi-squared tests and binary regression analysis tests were utilised in analysis. All interviews were conducted via telephone or online. An interview guide was developed. Interviews were conducted until data saturation was achieved. Qualitative interview data was analysed using the thematic analysis approach by Braun and Clarke, which identified and generated themes from the data. Results: The knowledge, attitude, and practice survey revealed that the pharmacist participants largely had poor knowledge levels, positive attitude levels and moderate practices relating to the care and treatment of VIB patients. No statistically significant association was observed between pharmacist participant demographics and knowledge, attitude and practice outcomes using the chi-square test. Binary logistic regression analysis revealed statistically significant association between hospital pharmacists and knowledge outcomes (aOR = 0.30;95% CI: 0.11 xvi -0.84). Regarding years of experience and knowledge outcomes, pharmacists with less than 5 years work experience had a statistically significant aOR value of 0.11 (95% CI: 0.02 – 0.59). A significant association was observed between participant qualifications and practice outcomes. Master’s degree holders had an aOR of 0.42 (95% CI: 0.18 – 0.98). Qualitative data highlighted issues of poor counselling practices and techniques in treating VIB patients. Pharmacists were observed and reported to possess poor knowledge levels of the VIB condition and those affected by it. The VIB participants reported the need for better pharmacist training and awareness on visual impairment and blindness. Techniques used by VIB participants in medication identification included, using braille, tactile markings, and different sized containers. The use of mobile phones and mobile assistive applications were common amongst VIB participants. Barriers to seeking pharmacy healthcare services included the absence of blind-friendly and accessibility features in pharmacies, and the lack of poor service delivery due to a lack of pharmacy policy and guidelines on the treatment and care of VIB patients. Conclusion: This study revealed the current state of pharmacy healthcare regarding the care and treatment of VIB patients in South Africa. The pharmacy healthcare needs of VIB patients are at present not sufficiently and appropriately being met. There is insufficient knowledge, and awareness of the VIB condition amongst pharmacists, which requires appropriate pharmacist training to amend. This study shed light on the medication management techniques and processes VIB patients implement. Observed VIB patient challenges highlighted the need for policy changes directed at the improvement of pharmacy facilities and standards of pharmaceutical healthcare for VIB individuals in South Africa