Psychometric validation of the VIP care battery and composite scale for vulnerable populations inclusiveness in pharmaceutical care – Nature

 

Report on the Psychometric Validation of an Inclusiveness Scale in Pharmaceutical Care and its Alignment with Sustainable Development Goals

Executive Summary

This report details a study aimed at validating a comprehensive assessment tool, the Vulnerable Populations Inclusiveness in Pharmaceutical Care (VIP-Care) battery and composite scale. The study assesses the multifaceted concept of inclusiveness among community pharmacists, a critical component for achieving the United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 10 (Reduced Inequalities). The research confirms the validity and reliability of the VIP-Care scale, identifies key factors influencing pharmacist inclusiveness, and provides a framework for targeted interventions to enhance health equity. The findings underscore the interplay between professional integrity, ethical conduct, and psychological wellness in delivering equitable pharmaceutical care to all, including marginalized populations.

1.0 Introduction: Inclusiveness in Healthcare and the Sustainable Development Agenda

The 2030 Agenda for Sustainable Development establishes a global mandate to ensure health and well-being for all. SDG 3 aims to “ensure healthy lives and promote well-being for all at all ages,” with a core target of achieving universal health coverage (UHC). This goal is intrinsically linked to SDG 10, which calls for reducing inequality within and among countries. Health equity, the principle that everyone has a fair opportunity to attain their full health potential, is the cornerstone of these goals. Achieving it requires dismantling discriminatory practices and addressing the social determinants of health that leave vulnerable populations underserved.

Pharmacists are pivotal in advancing this agenda. As accessible healthcare professionals, they can mitigate health disparities and promote inclusive care. However, the capacity of pharmacists to provide equitable services is influenced by their ethical attitudes, emotional intelligence, and personal well-being, especially in crisis-afflicted regions like Lebanon. Despite the global push for Diversity, Equity, Inclusion, and Antiracism (DEIA), a validated, comprehensive tool to measure inclusiveness in pharmaceutical care has been lacking. This study addresses this gap by validating a battery of tests and a composite scale to evaluate the components of inclusiveness among community pharmacists, providing a mechanism to monitor and improve progress towards health-related SDGs.

2.0 Methodology

2.1 Study Design and Population

A cross-sectional study was conducted among community pharmacists and pharmacy students in Lebanon. Data was collected via a self-administered online questionnaire, ensuring broad geographical representation. The study’s theoretical framework was grounded in social justice and equity principles, aligning with the foundational values of the SDGs.

2.2 Assessment Tools

The questionnaire collected sociodemographic data and utilized a battery of validated scales organized into three domains reflecting key aspects of inclusive healthcare practice:

• Health Equity, Professional Inclusivity, and Integrity: Assessed pharmacists’ commitment to providing accessible and equitable care for diverse and vulnerable populations, a direct measure of progress towards SDG 10.
• Moral and Ethical Perceptions: Measured ethical attitudes and moral reasoning, which are fundamental to building the just and strong institutions promoted by SDG 16 (Peace, Justice and Strong Institutions).
• Psychological Wellness and Interpersonal Skills: Evaluated emotional intelligence, empathy, well-being, and work fatigue, linking professional performance to the promotion of well-being as outlined in SDG 3 and the principles of decent work in SDG 8 (Decent Work and Economic Growth).

2.3 Statistical Analysis

The analysis involved robust psychometric validation procedures, including Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), to establish the construct and structural validity of the scales. A composite measure, the VIP-Care Scale, was derived. Multivariable regression and K-Means clustering were used to identify correlates of inclusiveness and profile pharmacists based on their scores.

3.0 Key Findings

3.1 Validation of the VIP-Care Battery

The study successfully validated the battery of tests. The scales demonstrated strong construct validity, structural validity, and excellent internal consistency. Factor analysis revealed a three-component structure for the VIP-Care battery:

1. Healthcare Equity, Inclusivity, and Professional Integrity: This component combines measures of accessibility, prioritization of vulnerable groups, professional commitment, and emotional intelligence.
2. Moral and Ethical Perceptions: This dimension includes scales on ethical practice, moral reasoning, and empathy, highlighting the ethical foundations of inclusive care.
3. Psychological Wellness and Interpersonal Skills: This component links pharmacist well-being with their scope of moral concern, underscoring that practitioner wellness is essential for a sustainable and equitable health system (SDG 3).

The work fatigue scale was excluded from the final battery due to a poor fit, though high fatigue levels were noted among participants, indicating a challenge to achieving SDG 8 targets for decent work environments.

3.2 Pharmacist Inclusiveness Levels and Correlates

The overall analysis revealed moderate levels of inclusiveness among the participants. Cluster analysis identified three distinct profiles: low, average, and high inclusiveness pharmacists.

Several factors were significantly associated with inclusiveness scores:

• Higher Inclusiveness: Associated with female gender (relevant to SDG 5 – Gender Equality), working in high-volume pharmacies (>100 patients/day), and having extensive experience (>12 years).
• Lower Inclusiveness: Linked to working fewer hours (1–16 per week) and the absence of a designated space for confidential patient consultations, which compromises patient dignity and privacy.

4.0 Discussion and Implications for Sustainable Development Goals

This study’s primary contribution is the validation of the VIP-Care battery, a novel tool for measuring and promoting inclusiveness in pharmaceutical care. This instrument provides a tangible way for health systems to monitor progress towards the equity-focused targets of SDG 3 and SDG 10.

The findings reveal a critical disconnect between pharmacists’ high emotional intelligence and their low empathy scores, possibly a coping mechanism against high work fatigue in a crisis setting. This highlights the urgent need to support the well-being of healthcare workers, a prerequisite for a resilient health system and a key tenet of both SDG 3 and SDG 8.

The factors associated with inclusiveness offer actionable insights. The positive association with female gender suggests that gender-responsive approaches in healthcare training may be beneficial (SDG 5). The lower inclusiveness associated with a lack of private consultation space points to an infrastructural barrier to equitable care. The complex, U-shaped relationship between experience and inclusiveness suggests that continuous professional development is vital for maintaining an inclusive mindset throughout a pharmacist’s career.

The lack of association between inclusiveness and educational background indicates a potential gap in pharmacy curricula. To advance the SDGs, educational institutions must integrate training on equity, social justice, and inclusive care into their core competencies.

5.0 Conclusion and Recommendations

This research successfully validated the VIP-Care battery and composite scale as a robust tool for assessing inclusiveness in pharmaceutical care. The study provides critical insights into the personal, professional, and environmental factors that shape equitable healthcare delivery.

To accelerate progress on the Sustainable Development Goals, the following actions are recommended:

1. Integrate the VIP-Care Scale: Healthcare organizations and educational institutions should use the VIP-Care scale to assess inclusiveness, identify gaps, and inform targeted training programs.
2. Enhance Pharmacy Education: Curricula should be updated to explicitly include competencies related to health equity, cultural humility, and care for marginalized populations, directly supporting SDG 3 and SDG 10.
3. Promote Pharmacist Well-being: Systemic interventions are needed to address work fatigue and burnout among pharmacists, ensuring a resilient and empathetic workforce capable of delivering high-quality, inclusive care (SDG 3, SDG 8).
4. Improve Pharmacy Infrastructure: Policies should ensure that pharmacies are equipped with private consultation areas to uphold patient dignity and facilitate inclusive communication.

By focusing on these areas, the pharmacy profession can significantly contribute to building a more inclusive, equitable, and sustainable healthcare future for all.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article primarily addresses issues related to two Sustainable Development Goals (SDGs):

1. SDG 3: Good Health and Well-being
   • The article explicitly mentions this goal in the introduction: “The 2030 Agenda for Sustainable Development, adopted by all United Nations Member States in 2015, states that Sustainable Development Goal 3 (SDG 3) is to ‘ensure healthy lives and promote well-being for all at all ages'”. The entire study is framed around improving healthcare delivery, specifically pharmaceutical care, which is a core component of achieving good health and well-being. The research focuses on inclusiveness, equity, and quality of care, all of which are fundamental to SDG 3. The article also measures the well-being of pharmacists themselves using the WHO-5 Well-Being Index, linking their wellness to the quality of care they can provide.
2. SDG 10: Reduced Inequalities
   • Although not explicitly named, SDG 10 is central to the article’s theme. The text is dedicated to addressing “health disparities for marginalized and vulnerable populations” and combating “discriminatory practices (e.g., racial, ethnic, gender, sexual orientation, economic, cultural, or linguistic)”. The study’s focus on inclusivity and equity in pharmaceutical care for groups such as refugees, sexual minorities, and people of different socioeconomic statuses directly aligns with the goal of reducing inequalities within and among countries. The development of the Population Prioritization and Equity Index (PPEI-24) is a clear attempt to measure and address these inequalities.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the article’s content, the following specific SDG targets can be identified:

1. Target 3.8: Achieve universal health coverage (UHC), including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
   • The article directly references this target by stating that SDG 3 has “specific targets that emphasize universal health coverage (UHC), equitable access to quality health services”. The study’s aim to validate a tool for measuring inclusiveness in pharmaceutical care is a direct effort to improve the quality and accessibility of these essential health services, particularly for underserved populations. The focus on “pharmacy’s accessibility” and “available resources” within the Pharmacy Inclusivity and Accessibility Scale (PIAS-13) directly relates to ensuring access to quality pharmaceutical care.
2. Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.
   • The article’s core concept of “inclusiveness in healthcare” aligns perfectly with this target. The research investigates how to ensure that marginalized groups are not “underrepresented and underserved”. The Population Prioritization and Equity Index (PPEI-24) was designed to evaluate care for a wide range of vulnerable groups, including “refugees, patients with sex identity problems, sex workers, those affected by socioeconomic status (SES)… sexual minorities, diverse religious and ethnic backgrounds,” which mirrors the inclusive language of Target 10.2.
3. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices and promoting appropriate legislation, policies and action in this regard.
   • The article highlights that “discriminatory practices… contribute significantly to health inequity.” The study’s focus on pharmacists’ ethical attitudes, moral behaviors, and potential biases is an attempt to understand and ultimately mitigate practices that lead to unequal health outcomes. The Moral Exception and Blame-Avoidance Scale (MEBAS) is used to measure practices that could lead to the exclusion or unfair treatment of certain populations, thereby addressing the root causes of outcome inequalities.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article is fundamentally about developing and validating a set of tools that can serve as indicators to measure progress towards the identified targets. The primary indicators are the scales that form the “VIP-Care battery” and the resulting composite score.

• The VIP-Care Scale (Composite Score): This composite measure serves as a high-level indicator of the overall inclusiveness of pharmaceutical care. A higher score on this scale would indicate better performance in providing equitable and accessible care, thus showing progress towards Targets 3.8, 10.2, and 10.3.
• Pharmacy Inclusivity and Accessibility Scale (PIAS-13): This scale acts as a direct indicator for Target 3.8 by measuring key components of accessible and quality healthcare, such as “pharmacy’s accessibility, culture and communication, and available resources.”
• Population Prioritization and Equity Index (PPEI-24): This index is a specific indicator for Targets 10.2 and 10.3. It measures the extent to which pharmacists provide equitable care to diverse and vulnerable populations, directly assessing whether inclusion is being practiced.
• Ethical and Moral Scales (EPPS-16, MEBAS): These scales measure the ethical and moral perceptions of pharmacists. They serve as indicators for Target 10.3 by assessing the prevalence of attitudes and behaviors that could lead to discriminatory practices and health inequities.
• WHO-5 Well-Being Index: While measuring the well-being of pharmacists, the article links this to their ability to provide compassionate and effective care. Therefore, it can be considered an indirect or enabling indicator for SDG 3, as the well-being of the health workforce is crucial for a functioning and high-quality health system.
• Correlates of Inclusiveness: The factors identified in the multivariable analysis, such as the “female gender,” “years of experience,” and the “absence of a suitable place in the pharmacy to discuss confidential information,” can be used as proxy indicators. For example, tracking the percentage of pharmacies with designated confidential spaces could be an indicator of progress towards creating a more inclusive environment that supports quality care (Target 3.8).

4. Table of SDGs, Targets, and Indicators

SDGs	Targets	Indicators
SDG 3: Good Health and Well-being	Target 3.8: Achieve universal health coverage (UHC) and access to quality essential healthcare services and medicines.	The composite VIP-Care Scale score. Scores on the Pharmacy Inclusivity and Accessibility Scale (PIAS-13). Scores on the Professional Commitment and Integrity Scale (PCIS-15). Scores on the WHO-5 Well-Being Index for healthcare professionals. Presence of a designated place for confidential discussions in pharmacies.
SDG 10: Reduced Inequalities	Target 10.2: Promote the social inclusion of all, irrespective of age, sex, disability, race, ethnicity, etc. Target 10.3: Ensure equal opportunity and reduce inequalities of outcome by eliminating discriminatory practices.	Scores on the Population Prioritization and Equity Index (PPEI-24). Scores on the Ethical Pharmacy Practice Scale (EPPS-16). Scores on the Moral Exception and Blame-Avoidance Scale (MEBAS). Scores on the Toronto Empathy Questionnaire (TEQ) as a measure of understanding diverse patient needs. Analysis of inclusiveness scores based on demographic factors (e.g., gender, experience) to identify disparities in service provision.

Source: nature.com