Structural awareness and knowledge of social determinants among pharmacists by practice settings and training eras

Pharmacists' ability to recognize structural factors - including socioeconomic conditions and systemic barriers - that influence patient health outcomes is critical for addressing health disparities. To build this capacity, social determinants of health (SDOH) and population health have become integral aspects of the pharmacy curriculum. However, whether their inclusion enhances structural awareness remains unknown. The study objectives were to determine whether structural awareness differs between pharmacists in hospital, ambulatory, and community settings; and between those trained by versus after the 2016 ACPE standards.

This secondary analysis utilized cross-sectional survey data from 477 licensed Minnesota pharmacists (108 ambulatory, 203 community, 166 hospital). Structural awareness was assessed using a modified Cultural Competence Self- Assessment Questionnaire. Participants were categorized by practice setting and licensure year (by 2016 versus after 2016). One-way ANOVA and independent t-tests compared mean scores across groups.

Mean structural awareness was similar across practice settings (ambulatory, community, hospital - η² = 0.008) and between training eras (by 2016, post-2016 - Cohen's d = 0.08). Item-level analyses revealed some variations: community and ambulatory pharmacists showed higher awareness of patient sociodemographic characteristics than hospital pharmacists. Ambulatory care pharmacists reported higher utilization of interpreter services. All groups had low mean scores on knowledge of population health metrics.

Despite ACPE mandates, structural awareness remains moderate across pharmacy settings and training eras. Findings suggest didactic instruction alone may be insufficient. Community-engaged experiential learning and explicit training in population health assessment may be needed to develop structural competency and advance the contribution of pharmacy to health equity.