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. 2025 Jan 16;158(3):140–147. doi: 10.1177/17151635241305375

Pharmacist accessibility for non-native Japanese speakers: A cross-sectional study in Japan

Shota Suzuki 1,2,3,✉, Yoshitaka Nishikawa 4, Takeo Nakayama 5, Hiroshi Okada 6,7
PMCID: PMC11748378  PMID: 39844886

Abstract

Background:

Pharmacists, being one of the more readily accessible primary health care professionals, must ensure accessibility. With growing internationalization, those in Japanese community pharmacies increasingly interact with non-Japanese speakers. This study aimed to understand how Japanese pharmacies can fulfill accessibility needs by accounting for patients’ native language and culture.

Methods:

A cross-sectional survey of community pharmacies in 2 Japanese municipalities (Hirakata and Suma) was conducted between September and October, 2022. The survey questionnaire included questions on “interaction with non-native Japanese speakers”, “impressions during dialogue”, and “characteristics and preparedness of pharmacies”. The responses were analyzed using descriptive statistics.

Results:

The response rate was 30.9% (46/149) in Hirakata and 50.0% (29/58) in Suma. The frequency of contact with non-native Japanese speakers at least once a month was 47.8% (22/46) in Hirakata and 55.2% (16/29) in Suma. The main purpose of the visits was to obtain prescription medicines. English was the most commonly used language, as seen on the website, patient forms, medicine bags, informational materials, and staff language skills. However, fewer than half of the stores offered this service. Chinese, Korean, and Vietnamese were even less common.

Discussion:

Pharmacists, often recognized for their accessibility among primary health care providers, demonstrated limited readiness to serve non-native Japanese speakers in the surveyed regions. To enhance service to diverse pharmacy visitors, improved preparedness for linguistic and cultural differences and cultural competence education are recommended.

Conclusion:

Japanese pharmacies face barriers in providing language-aligned care to service visitors with diverse linguistic and cultural backgrounds. By preparing for linguistic differences and providing cultural competency education, pharmacies can improve accessibility to effectively serve diverse populations.

Knowledge into Practice.

  • As accessible primary health care professionals, pharmacists need to be easily accessible to their patients; as internationalization continues to evolve, it is becoming increasingly crucial for pharmacies to consider the needs of visitors from diverse backgrounds.

  • The extent to which Japanese community pharmacies can provide adequate language services to non-native Japanese speakers remains unclear.

  • Pharmacies in 2 regions of Japan (Hirakata and Suma) were unwilling to provide multilingual services to non-native Japanese speakers.

  • To enhance accessibility for non-native Japanese-speaking residents, it would be effective to expand the use of multilingual equipment and provide culturally competent education.

Introduction

To attain the objective of “leave no one behind,” which is a key principle of Japan’s Sustainable Development Goals (SDGs), it is essential to embrace diversity in alignment with the tenets of primary health care.1,2 In contemporary globalized society, the health care sector must also acknowledge the diversity of its users. 3 It is established that patients tend to prefer primary care physicians of the same race and ethnicity as themselves and that their presence is crucial. Indeed, it is also established that patient outcomes are enhanced when patients and physicians converse in the same language. 4 However, racial and ethnic disparities exist among health care professionals, and patients report challenges in identifying a preferred provider. 5

Community pharmacies are defined as places where pharmacists provide primary health care, which includes not only the procurement of medicines but also self-care and preventive counselling. 6 This role has also led to the description of pharmacists as accessible primary health care providers. 7 Given the diverse range of individuals who visit pharmacies, accessibility that accommodates this diversity is essential. 8 The World Health Organization (WHO) has emphasized the importance of accessibility through its Availability, Accessibility, Acceptability, and Quality (AAAQ) framework. 9 In the past, language barriers have been identified as a significant challenge to achieving accessibility (information) and acceptability in the English-speaking world.10-16 Over the past few years, there has been a notable increase in the internationalization of pharmacy services, leading to a widespread problem of communication barriers for patients who do not speak the native language of the country they are visiting. This problem is particularly prevalent in countries where English is not the primary language, and efforts are being made to address this issue.17-20

Mise En Pratique Des Connaissances.

  • En tant que professionnels de soins de santé primaires, les pharmaciens doivent être facilement accessibles à leurs patients. Et à mesure de l’évolution de l’internationalisation, il devient de plus en plus crucial que les pharmacies tiennent compte des besoins des visiteurs issus de divers horizons.

  • La capacité des pharmacies communautaires du Japon à offrir des services linguistiques adéquats aux patients dont la langue maternelle n’est pas le japonais demeure imprécise.

  • Les pharmacies de deux régions du Japon (Hirakata et Suma) n’étaient pas disposées à offrir des services multilingues aux patients dont la langue maternelle n’est pas le japonais.

  • Pour améliorer l’accessibilité aux soins des résidents dont la langue maternelle n’est pas le japonais, il serait efficace de renforcer l’utilisation de matériel multilingue et de former les pharmaciens à l’offre de soins adaptés sur le plan culturel.

In recent years, there has been a notable increase in Japan’s foreign population. This has led to an urgent need to develop pharmacies that can accommodate foreign visitors in different languages and cultures. Despite its modest size, Japan has become a highly sought-after tourist destination, offering a wealth of natural beauty, a distinctive cultural heritage, and a high level of safety. After experiencing a significant downturn due to the COVID-19 pandemic, which led to the curbing of human movement, the number of international tourists visiting Japan has regained momentum and is now on the rise.21-24 Although Japanese people are taught English education from an early age, many Japanese people continue to use Japanese in public settings, leading to communication challenges with non-Japanese speakers. 25 Indeed, staff members of the pharmacy located near a medical facility that frequently treats foreign patients have faced challenges in communicating with non-native Japanese speakers. 20 In light of these considerations, Japan provides an illustrative case for examining the challenges and complexities associated with providing pharmacy services to visitors with different language backgrounds.

Another issue to consider is that of mid- to long-term residents whose native languages are other than Japanese and English. In 2018, Japan’s revised Immigration Control Act established a new residency status for foreigners, and many foreigners from Southeast Asian countries have moved to Japan.26,27 Given that they are not necessarily native English speakers, they are encouraged to communicate in Yasashii Nihongo, which is simpler than regular Japanese and easier for non-native Japanese speakers to understand. 28 Furthermore, differences in the roles of pharmacies and pharmacists due to variations in health care systems between their home countries and Japan can lead to confusion about medications that are readily available elsewhere but not in Japan. 29

Although the number of non-native Japanese speakers is expected to continue to increase, no studies have been conducted on the accessibility of Japanese community pharmacies to individuals from diverse linguistic and cultural backgrounds. Accordingly, this study sought to ascertain the extent to which Japanese pharmacies are equipped to accommodate users from diverse linguistic and cultural backgrounds.

Methods

Study design and participants

This cross-sectional study was conducted in Hirakata City, Osaka Prefecture (Hirakata) and Suma Ward, Kobe City, Hyogo Prefecture (Suma), from September to October, 2022 (Figure 1). Hirakata has a city-level pharmacist association, whereas Suma is located in a government-designated city and thus has a ward-level pharmacist association. In these 2 areas, we were able to identify pharmacists who expressed interest in the content of the study and were willing to serve as contact points for conducting the survey.

Figure 1.

Figure 1

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Geographical locations of Hirakata and Suma

Study locations

Hirakata

As of January 1, 2023, the population of the area was 396,252. 30 As of December 3, 2022, there were 5430 foreign residents, the majority of whom were from China (1504, 27.7%), South Korea (1091, 20.1%), and Vietnam (1085, 20.0%). 31 The official website provided basic living information in English, Chinese, Korean, Spanish, Portuguese, and Vietnamese. 32 The city has a university hospital (Kansai Medical University Hospital), a large shopping mall (Kuzuha Mall), an amusement park (Hirakata Park), a medical school (Kansai Medical University), and a language school (Kansai Gaidai University) 33 (Appendix Figure 1, available online in Supplementary Materials).

Suma

As of January 1, 2023, the area had a population of 156,368. 34 As of December 3, 2022, there were 3586 foreign residents, mostly from South Korea (2056, 57.3%), China (480, 13.4%), and Vietnam (257, 7.2%). 31 The official website provided basic living information in English, Chinese, Korean, Spanish, Portuguese, Vietnamese, Nepali, Indonesian, Filipino, and Thai. 35 The city has a national hospital (National Hospital Organization, Kobe Medical Center), recreational facilities (Suma Beach, Kobe Sports Park Baseball Stadium), and a medical university (Kobe University) 36 (Appendix Figure 2).

Survey instrument

The survey questionnaire was developed based on questions used in previous studies11,37-40 and underwent subsequent revisions following discussions with group members. After pilot testing with pharmacists, the questions were revised based on feedback from the participants. The questionnaire was designed to take approximately 15 minutes to complete and consisted of 4 sections: “Interaction with non-native Japanese speakers”, “Impressions during dialogue”, “Impact of the coronavirus disease 2019 pandemic”, and “Characteristics and preparedness of pharmacies”.

Data collection

The researchers requested the assistance of pharmacist associations to conduct the survey. This request was made through collaborators affiliated with the Hirakata and Suma pharmacist associations. After confirming the willingness of the pharmacists to participate, the association distributed instructions and questionnaires to each store. To ensure the integrity of the sampling process, all pharmacies affiliated with the 2 regional associations were invited to participate. Each store was asked to respond once, with the designated respondent being the sole pharmacist responsible for managing the store. No direct incentives were offered to the pharmacies participating in the study. The pharmacy association sent a faxed reminder before the designated response date. The survey was conducted between September and October, 2022, and the researcher subsequently analyzed the data. Before the analysis, the data were anonymized by the pharmacists’ associations to ensure the anonymity of the stores.

Measures

The following aspects were evaluated regarding the circumstances of the past year:

  • Frequency of interaction with non-native Japanese speakers and the purpose of their visits.

  • Perception of involvement, specifically in terms of anxiety.

  • The characteristics and readiness of pharmacies, including zip code, store type, languages spoken by non-native Japanese speakers, multilingual capabilities (websites, patient forms, medicine bags, informational materials, and language skills of staff), recruitment policies, availability of interpreter services, and availability of translation equipment.

Data analysis

Data preparation involved screening for and handling outliers and inconsistencies in the raw data. Descriptive statistics were used to summarize the data, including frequencies and percentages: n (%). The results were tabulated separately for each pharmacist association to allow for comparison between different regions or organizational structures. Missing values were excluded from the tabulation. The analysis was conducted using JMP Pro 16 software (SAS Institute Inc., Cary, NC, USA).

Ethical approval

This study was approved by the Nara Medical University Ethics Committee (Approval No. 3265) and conducted in accordance with the Ethical Guidelines for Medical and Biological Research Involving Human Subjects.

Results

The response rates were 30.9% (46/149) in Hirakata and 50.0% (29/58) in Suma (Figure 2). There were no duplicate responses in either region.

Figure 2.

Figure 2

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Flow chart

Characteristics of participating pharmacies

Table 1 summarizes the characteristics of the participating stores. Both regions had a high prevalence of individual or small chain pharmacies (Hirakata: 51.1%; Suma: 72.4%). The most common frequency of encounters with non-native Japanese speakers was “A few (2–3) times a year” (Hirakata: 39.1%; Suma: 31.0%). However, a substantial proportion of respondents encountered such visitors more frequently, with approximately half reporting encounters more than once a month (Hirakata: 47.8%; Suma: 55.2%). Most users visited pharmacies to obtain prescription medicines, followed by the purchase of over-the-counter medicines. None of the users visited the pharmacy for health consultation. Non-native Japanese speakers were most likely to use English as a language other than Japanese. Visitors using Chinese, Spanish, Korean, Vietnamese, or Portuguese were also reported in some stores.

Table 1.

Information on participating pharmacies, n (%)

Characteristics Hirakata Suma
Store type n = 45
 n = 29
 Health insurance pharmacy* (single to less than 15) 23 (51.1)
 21 (72.4)
 Health insurance pharmacy* (more than 15) 21 (46.7)
 7 (24.1)
 Drugstore 1 (3.3) 1 (3.4)
Frequency of contact with non-native Japanese speakers n = 46 n = 29
 Almost every day 1 (2.2) 2 (6.9)
 Once a week 2 (4.3) 6 (20.7)
 A few (2–3) times a month 10 (21.7) 3 (10.3)
 Once a month 9 (19.6) 5 (17.2)
 A few (2–3) times a year 18 (39.1) 9 (31.0)
 Once a year 2 (4.3) 1 (3.4)
 Never 4 (8.7) 3 (10.3)
Purpose of visit by non-native Japanese speakers** n = 42
 n = 26
 Purchase of prescription medicines (prescription dispensing) 41 (97.6)
 25 (96.2)
 Purchase of over-the-counter medicines 4 (9.5)
 3 (11.5)
 Purchase of non-pharmaceutical items 1 (2.4)
 0 (0)
 Health consultation 0 (0) 0 (0)
Languages used by non-native Japanese speakers** n = 41 n = 26
 Japanese 27 (65.9) 20 (76.9)
 English 24 (58.5) 14 (53.8)
 Chinese (Mandarin) 8 (19.5) 7 (26.9)
 Spanish 0 (0) 2 (7.7)
 Korean 2 (4.9) 2 (7.7)
 Vietnamese 5 (12.2) 2 (7.7)
 Portuguese 1 (2.4) 1 (3.8)
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*

Health insurance pharmacy 41 : A dispensing pharmacy that has a special insurance designation and can fill prescriptions through the public insurance system.

**

Multiple items may apply to 1 patient.

Multilingual preparedness at each pharmacy

Table 2 summarizes the extent of multilingual capabilities at each pharmacy store. English was the most prevalent language across all facilities, but fewer than half of the stores reported any degree of linguistic accommodation. Furthermore, only 1 or 2 stores reported providing accommodations in Chinese, Korean, Vietnamese, and other languages. Only about half of the stores provided accommodations in Yasashii Nihongo, which was promoted for use. Both regions lacked policies regarding the hiring of staff fluent in their language, the use of interpreters, and the provision of translation equipment (Table 3).

Table 2.

Multilingual preparedness of each pharmacy, n (%)

English Chinese (Mandarin) Spanish Korean Vietnamese Portuguese Yasashii Nihongo*
Website
 Hirakata (n = 36) 5 (13.9) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 5 (13.9)
 Suma (n = 16) 1 (6.3) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 5 (31.3)
Patient forms
 Hirakata (n = 46) 4 (8.7) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 7 (15.2)
 Suma (n = 29) 9 (31.0) 2 (6.9) 1 (3.4) 1 (3.4) 1 (3.4) 0 (0) 5 (17.2)
Medicine bags
 Hirakata (n = 46) 3 (6.5) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 8 (17.4)
 Suma (n = 29) 7 (24.1) 0 (0) 0 (0) 1 (3.4) 0 (0) 0 (0) 3 (10.3)
Informational materials
 Hirakata (n = 46) 16 (34.8) 1 (2.2) 1 (2.2) 2 (4.3) 0 (0) 0 (0) 7 (15.2)
 Suma (n = 29) 8 (27.6) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 3 (10.3)
Language skills of pharmacist
 Hirakata (n = 46) 11 (23.9) 2 (4.3) 1 (2.2) 1 (2.2) 0 (0) 0 (0) 20 (43.5)
 Suma (n = 29) 3 (10.3) 0 (0) 0 (0) 1 (3.4) 0 (0) 0 (0) 16 (55.2)
Language skills of other staff members
 Hirakata (n = 46) 6 (13.0) 1 (2.2) 1 (2.2) 2 (4.3) 0 (0) 0 (0) 18 (39.1)
 Suma (n = 29) 2 (6.9) 0 (0) 0 (0) 1 (3.4) 0 (0) 0 (0) 15 (51.7)
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*

Yasashii Nihongo 28 : Japanese that is simpler than ordinary Japanese and easier for non-Japanese to understand.

Table 3.

Other pharmacy provisions, n (%)

Hirakata Suma
When recruiting staff, do you actively seek employees with foreign language skills? (Recruitment policy) n = 40 n = 29
 Present 8 (20.0) 3 (10.3)
 Absent 32 (80.0) 26 (89.7)
Does your pharmacy have access to interpreters when needed? (Interpreter service) n = 42 n = 28
 Present 1 (2.4) 0 (0)
 Absent 41 (97.6) 28 (100)
Are translation devices available in your pharmacy? (Translation equipment) n = 42 n = 29
 Present 3 (7.2) 2 (6.9)
 Absent 39 (92.8) 27 (93.1)
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Pharmacists’ concerns about dealing with non-native Japanese speakers

Of the pharmacies surveyed, 78.3% (36/46) in Hirakata and 72.4% (21/29) in Suma reported concern about dealing with non-Japanese speakers. One store in both regions reported no concern at all (Table 4).

Table 4.

Pharmacists’ concerns regarding dealing with non-native Japanese speakers, n (%)

Hirakata Suma
Impressions of interaction with non-native Japanese speakers n = 46 n = 29
Anxious 36 (78.3) 21 (72.4)
 Extremely anxious 13 (28.3) 7 (24.1)
 Somewhat anxious 23 (50.0) 14 (48.3)
Neutral, inconclusive 7 (15.2) 4 (13.8)
Not anxious 3 (6.5) 4 (13.8)
 Not very anxious 3 (6.5) 3 (10.3)
 Not anxious at all 0 (0) 1 (3.4)
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Discussion

In this study, which sought to understand how Japanese pharmacies can fulfill accessibility needs accounting for patients’ native languages and cultures, the findings suggest that Japanese pharmacies face barriers in providing language-aligned care to non-native Japanese speakers. Even English, the most common language offered, was only available in less than half of the stores. In addition, the study area was home to many foreign residents of Chinese, Vietnamese, and Korean descent. Although many pharmacies had previous experience with these individuals, the pharmacies were less equipped to interact with the individuals in their native language. These findings suggest that it may be difficult to find a pharmacy that provides services in languages other than Japanese, which may pose a challenge for people who need pharmacy services.

Most respondents were independent or small chain pharmacies, which may have contributed to the delay in implementing multilingual preparedness measures in these settings. As accessible primary care professionals, pharmacists are expected to perform a range of functions, including health consultation and the provision of medicines. The results of the survey conducted at the stores indicated that none of the non-native Japanese speakers availed themselves of health consultation services, underscoring the impact of language barriers on accessibility.

To improve pharmacy accessibility, pharmacists should effectively communicate with non-native English speakers by considering their language preferences. Recently, many mid- to long-term residents have come from Asian countries, where their native languages include Chinese, Korean, and Vietnamese. Although their ability to communicate in English may not be guaranteed, their familiarity with the Japanese language is often present. The most common language used to communicate with non-native Japanese-speaking pharmacy visitors was Japanese, followed by English. In Japan, promoting the use of Yasashii Nihongo, a simplified form of Japanese that is more accessible to non-native speakers, has been encouraged. The results of this survey reveal a lack of awareness of Yasashii Nihongo among pharmacies, suggesting that its adoption for future use is desirable. 28

To enhance the accessibility of pharmacies to non-native Japanese speakers, it is important to implement a system that encompasses the internal operations of each pharmacy and a collaborative approach with the broader community. Potential strategies may include evaluating the language proficiency of pharmacy staff during the hiring process, implementing a system in which stores can request interpreters as needed, and installing translation devices to facilitate communication. Despite the potential for inaccuracy, the accuracy of machine translation accessible via smartphones and tablets is improving, and this is a readily available technology that can be implemented in all pharmacies. 42 The feasibility of supporting all languages globally has been acknowledged as unattainable. However, it is important to consider the languages required in a specific region by referring to the local information available on official government websites. To achieve this, the relevant languages can be identified, coordinated with the pharmacist association, and developed in collaboration with the government in that region.32,35

Similarly, pharmacists must enhance their understanding of the cultural background and medical framework associated with the countries of origin of non-native Japanese speakers. The term cultural competence is widely used in international contexts. Cultural competence describes the ability to engage ethically and effectively in cross-cultural settings, both personal and professional. This ability can contribute to the richness and creativity of society by fostering respect for diversity.43,44 Just as it is a standard practice for pharmacists to adjust the dosage of a renal drug for patients with kidney disease, it is equally important to educate ourselves about interacting with patients whose native language is different from our own, considering the impact of language and cultural differences. One potential solution to improve cultural competency in Japanese pharmacy education is to incorporate this topic into the curriculum and develop educational materials.45-47 Given the projected increase in the number of non-native Japanese speakers, it is critical to move beyond interventions that are accessible only to Japanese individuals. This shift is essential to achieving the “leave no one behind” goal of the SDGs. 48

Limitations

The present study had several limitations. First, a low response rate was observed, which could be attributed to the fact that the survey was conducted during the COVID-19 pandemic, during which non-face-to-face communication was required and pharmacists simultaneously struggled with high workloads. To mitigate this issue, follow-up messages were sent during the study period to improve the response rate. Second, the results were limited to 2 specific regions in Japan. Given the considerable variation in the characteristics of foreign populations residing in or visiting different regions, it is possible that the results may not accurately reflect the situation in Japan as a whole. To reduce the likelihood of bias, the survey was conducted through a pharmacy association that provided a comprehensive survey for the specified region. Third, the study used a method that elicited responses from a single pharmacy manager representing the store and did not explore the perceptions of other employees. And finally, it was not possible to collect data on variables that could potentially affect the provision of services at different times of the day, such as the working hours of staff members who were able to communicate in different languages. Further research is needed to gain a complete understanding of the challenges and opportunities associated with serving non-native Japanese speakers in community pharmacies.

Conclusion

Pharmacists are responsible for adhering to the AAAQ framework in health care provision. Unfortunately, our study reveals that many Japanese pharmacies face barriers in providing language-aligned care to serve visitors of diverse linguistic and cultural backgrounds. Specifically, language barriers potentially affect the quality and safety of pharmaceutical care for non-native Japanese speakers. There is a pressing need for systematic improvements to ensure equitable, high-quality pharmaceutical care for all visitors, regardless of their linguistic or cultural background. Overall, by preparing for linguistic differences and providing cultural competency education, pharmacies can improve accessibility to effectively serve diverse populations. ■

Supplemental Material

sj-pdf-1-cph-10.1177_17151635241305375 – Supplemental material for Pharmacist accessibility for non-native Japanese speakers: A cross-sectional study in Japan
sj-pdf-1-cph-10.1177_17151635241305375.pdf (228.4KB, pdf)

Supplemental material, sj-pdf-1-cph-10.1177_17151635241305375 for Pharmacist accessibility for non-native Japanese speakers: A cross-sectional study in Japan by Shota Suzuki, Yoshitaka Nishikawa, Takeo Nakayama and Hiroshi Okada in Canadian Pharmacists Journal / Revue des Pharmaciens du Canada

Acknowledgments

We express our sincere gratitude to the Hirakata and Suma Pharmacists Associations and the Pharmacy Informatics Group, especially Ms Naomi Tokura and Mr Taiji Kuroda, for their invaluable cooperation in facilitating the survey. We are deeply indebted to Professor Ross T. Tsuyuki for his expert advice on the issues raised in the paper. We are also deeply grateful to Ms Miku Araki and Ms Ayumi Kado for their meticulous assistance in data validation.

Footnotes

Author Contributions: All authors designed the study. S. Suzuki collected, managed, and analyzed the data and drafted the original manuscript. Y. Nishikawa and H. Okada reviewed, revised, and approved the final manuscript. T. Nakayama supervised the project and reviewed, revised, and approved the final manuscript.

Y. Nishikawa received a donation from Datack Co. T. Nakayama received grants from I&H Co. Ltd., Cocokarafine Group Co. Ltd., Konica Minolta Inc., and NTT DATA; consulting fees from Otsuka Pharmaceutical Co., Takeda Pharmaceutical Co., Johnson & Johnson K.K., and Nippon Zoki Pharmaceutical Co. Ltd; and honoraria from Pfizer Japan Inc., MSD K.K., Chugai Pharmaceutical Co., Takeda Pharmaceutical Co., Janssen Pharmaceutical K.K., Boehringer Ingelheim International GmbH., Eli Lilly Japan K.K., Maruho Co. Ltd., Mitsubishi Tanabe Pharma Co., Novartis Pharma K.K., Allergan Japan K.K., Novo Nordisk Pharma Ltd., Toa Eiyo Ltd., Dentsu Co., Ono Pharmaceutical Co. Ltd., GSK plc, Alexion Pharmaceuticals, Inc., Cannon Medical Systems Co., Kowa Company Ltd., and Araya AbbVie Inc. H. Okada received donations from Yuyama Co. Ltd., Ishizuka Co., Frant Co., and Neoplus Pharma Co. S. Suzuki reports no conflict of interest.

Funding: This research did not receive any grants from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical Approval: This study was approved by the Nara Medical University Ethics Committee (Approval No. 3265) and conducted in accordance with the Ethical Guidelines for Medical and Biological Research Involving Human Subjects.

Supplemental Material: Supplemental material for this article is available online.

Contributor Information

Shota Suzuki, Department of Social & Community Pharmacy, School of Pharmaceutical Sciences, Wakayama Medical University, Wakayama, Japan; Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan; Institute for Clinical and Translational Science, Nara Medical University Hospital, Nara, Japan.

Yoshitaka Nishikawa, Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan.

Takeo Nakayama, Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan.

Hiroshi Okada, Department of Social & Community Pharmacy, School of Pharmaceutical Sciences, Wakayama Medical University, Wakayama, Japan; Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan.

References

  • 1. Singh I. Understanding of cultural competence is essential for the delivery of compassionate, fair, and proportionate medical regulations. Lancet 2023;402:434-5. doi: 10.1016/S0140-6736(23)00524-X [DOI] [PubMed] [Google Scholar]
  • 2. Hone T, Macinko J, Millett C. Revisiting Alma-Ata: what is the role of primary health care in achieving the Sustainable Development Goals? Lancet 2018;392:1461-72. doi: 10.1016/S0140-6736(18)31829-4 [DOI] [PubMed] [Google Scholar]
  • 3. Brolan CE, Forman L, Dagron S, et al. The right to health of non-nationals and displaced persons in the sustainable development goals era: challenges for equity in universal health care. Int J Equity Health 2017;16:14. doi: 10.1186/s12939-016-0500-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4. Seale E, Reaume M, Batista R, et al. Patient-physician language concordance and quality and safety outcomes among frail home care recipients admitted to hospital in Ontario, Canada. CMAJ 2022;194:E899-908. doi: 10.1503/cmaj.212155 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5. Ku L, Vichare A. The association of racial and ethnic concordance in primary care with patient satisfaction and experience of care. J Gen Intern Med 2023;38:727-32. doi: 10.1007/s11606-022-07695-y [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6. Rutter P. Role of community pharmacists in patients’ self-care and self-medication. Integr Pharm Res Pract 2015;4:57-65. doi: 10.2147/IPRP.S70403 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7. Tsuyuki RT, Beahm NP, Okada H, Al Hamarneh YN. Pharmacists as accessible primary health care providers: review of the evidence. Can Pharm J (Ott) 2018;151:4-5. doi: 10.1177/1715163517745517 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8. Watson KE, Tsuyuki RT, Dixon DL, Liu S, Al Hamarneh YN. Accessibility reality check. Can Pharm J (Ott) 2024;157:155-60. doi: 10.1177/17151635241256621 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9. UNICEF. Availability, Accessibility, Acceptability and Quality framework: a tool to identify potential barriers in accessing services in humanitarian settings. 2019. Available: https://gbvguidelines.org/wp/wp-content/uploads/2019/11/AAAQ-framework-Nov-2019-WEB.pdf (accessed Jul. 27, 2024).
  • 10. Westberg SM, Sorensen TD. Pharmacy-related health disparities experienced by non-English-speaking patients: impact of pharmaceutical care. J Am Pharm Assoc (2003) 2005;45:48-54. doi: 10.1331/1544345052843066 [DOI] [PubMed] [Google Scholar]
  • 11. Bradshaw M, Tomany-Korman S, Flores G. Language barriers to prescriptions for patients with limited English proficiency: a survey of pharmacies. Pediatrics 2007;120:e225-35. doi: 10.1542/peds.2006-3151 [DOI] [PubMed] [Google Scholar]
  • 12. Schwappach DL, Meyer Massetti C, Gehring K. Communication barriers in counselling foreign-language patients in public pharmacies: threats to patient safety? Int J Clin Pharm 2012;34:765-72. doi: 10.1007/s11096-012-9674-7 [DOI] [PubMed] [Google Scholar]
  • 13. Alhomoud F, Dhillon S, Aslanpour Z, Smith F. Medicine use and medicine-related problems experienced by ethnic minority patients in the United Kingdom: a review. Int J Pharm Pract 2013;21:277-87. doi: 10.1111/ijpp.12007 [DOI] [PubMed] [Google Scholar]
  • 14. Alhomoud F, Dhillon S, Aslanpour Z, Smith F. South Asian and Middle Eastern patients’ perspectives on medicine-related problems in the United Kingdom. Int J Clin Pharm 2015;37:607-15. doi: 10.1007/s11096-015-0103-6 [DOI] [PubMed] [Google Scholar]
  • 15. Bellamy K, Ostini R, Martini N, Kairuz T. Perspectives of resettled African refugees on accessing medicines and pharmacy services in Queensland, Australia. Int J Pharm Pract 2017;25:358-64. doi: 10.1111/ijpp.12324 [DOI] [PubMed] [Google Scholar]
  • 16. Chang E, Tsang B, Thornley S. Language barriers in the community pharmacy: a survey of northern and western Auckland. J Prim Health Care 2011;3:102-6. doi: 10.1071/HC11102 [DOI] [PubMed] [Google Scholar]
  • 17. Harmsen JA, Bernsen RM, Bruijnzeels MA, Meeuwesen L. Patients’ evaluation of quality of care in general practice: what are the cultural and linguistic barriers? Patient Educ Couns 2008;72:155-62. doi: 10.1016/j.pec.2008.03.018 [DOI] [PubMed] [Google Scholar]
  • 18. Koster ES, Blom L, Winters NA, van Hulten RP, Bouvy ML. Interpretation of drug label instructions: a study among four immigrants groups in the Netherlands. Int J Clin Pharm 2014;36:274-81. doi: 10.1007/s11096-013-9873-x [DOI] [PubMed] [Google Scholar]
  • 19. Hakonsen H, Lees K, Toverud EL. Cultural barriers encountered by Norwegian community pharmacists in providing service to non-Western immigrant patients. Int J Clin Pharm 2014;36:1144-51. doi: 10.1007/s11096-014-0005-z [DOI] [PubMed] [Google Scholar]
  • 20. Suzuki S, Kato ET, Sato K, et al. The effect of the Original MethOd at pharmacy To ENhAnce Support for Health Improvement in the limited Japanese proficiency patients visiting local community pharmacy: a randomized controlled trial. Patient Educ Couns 2022;105:366-74. doi: 10.1016/j.pec.2021.05.034 [DOI] [PubMed] [Google Scholar]
  • 21. World Economic Forum. Travel & Tourism Development Index 2024: rebuilding for a sustainable and resilient future. 2024. Available: https://www3.weforum.org/docs/WEF_Travel_and_Tourism_Development_Index_2024.pdf (accessed Jul. 27, 2024).
  • 22. Japan National Tourism Organization. Visitor arrivals, Japanese overseas travelers. 2022. Available: https://www.jnto.go.jp/statistics/data/marketingdata_outbound_2022.pdf (accessed Jul. 27, 2024).
  • 23. Suzuki S, Nishikawa Y, Okada H, Nakayama T. Information-seeking behaviour of community pharmacists during the COVID-19 pandemic: an ecological study. BMJ Open 2023;13:e062465. doi: 10.1136/bmjopen-2022-062465 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24. Suzuki S, Okada H, Nakayama T. Communication with non-Japanese residents at the pharmacies under the COVID-19 pandemic-dissemination of information via the website and future prospects. Journal of the Japan Primary Care Association 2020;43(1):158-60. [Google Scholar]
  • 25. Kawaguchi-Suzuki M, Law MG, Prisco J, et al. Cultural sensitivity and global pharmacy engagement in Asia: China, Japan, South Korea, and Taiwan. Am J Pharm Educ 2019;83:7214. doi: 10.5688/ajpe7214 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26. Immigration Services Agency. Explanatory materials for “Specified Skilled Worker”, etc. 2020. Available: https://www.moj.go.jp/isa/policies/ssw/nyuukokukanri01_00133.html (accessed Jul. 27, 2024).
  • 27. Immigration Services Agency. Regarding the number of foreign residents as of the end of 2022. 2024. Available: https://www.moj.go.jp/isa/publications/press/13_00040.html?hl=en (accessed Jul. 27, 2024).
  • 28. Ito H, Tokarev A. From Yasashii Nihongo in non-disaster times towards a plurilingual language education approach: an outlook from the perspective of “reasonable accommodation”. F1000Res 2021;10:52. doi: 10.12688/f1000research.36372.2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29. Kawaguchi-Suzuki M, Hogue MD, Khanfar NM, et al. Cultural sensitivity and global pharmacy engagement in Asia: India, Indonesia, Malaysia, Philippines, and Vietnam. Am J Pharm Educ 2019;83:7215. doi: 10.5688/ajpe7215 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30. Osaka Prefectural Government. Basic resident ledger population of Osaka Prefecture (as of January 1, 2023). Available: https://www.pref.osaka.lg.jp/shichoson/juki/juki05.html (accessed Jul. 27, 2024).
  • 31. e-Stat. Foreign resident statistics. 2022. Available: https://www.e-stat.go.jp/stat-search/files?page=1&layout=datalist&toukei=00250012&tstat=000001018034&cycle=1&year=20220&month=24101212&tclass1=000001060399&stat_infid=000040068661&result_back=1&cycle_facet=tclass1&tclass2val=0 (accessed Jul. 27, 2024).
  • 32. Hirakata City. Hirakata living guidebook. 2023. Available: https://www.city.hirakata.osaka.jp/0000000313.html (accessed Jul. 27, 2024).
  • 33. Google Map. My Maps. Hirakata City. (Produced by S.S.). 2023. Available: https://www.google.com/maps/d/u/0/edit?mid=1gkF64iyDxkpogA9LEo4YMWuGbXnr8B4&usp=sharing (accessed Jul. 27, 2024).
  • 34. Hyogo Prefecture. Estimated population of Hyogo prefecture. 2023. Available: https://web.pref.hyogo.lg.jp/press/20230131_12253.html (accessed Jul. 27, 2024).
  • 35. Kobe City. Kobe living guide. 2023. Available: https://www.kicc.jp/en/living_guide (accessed Jul. 27, 2024).
  • 36. Google Map. My Maps. Suma Ward. (Produced by S.S.). Available: https://www.google.com/maps/d/u/0/edit?mid=1CwWnlHkFUt1xJ0-x4D6TKe8pg453ivg&usp=sharing (accessed Jul. 27, 2024).
  • 37. Weiss L, Gany F, Rosenfeld P, et al. Access to multilingual medication instructions at New York City pharmacies. J Urban Health 2007;84:742-54. doi: 10.1007/s11524-007-9221-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38. Weiss L, Scherer M, Chantarat T, et al. Assessing the impact of language access regulations on the provision of pharmacy services. J Urban Health 2019;96:644-51. doi: 10.1007/s11524-018-0240-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39. Plombon M, Religioni U, Neumann-Podczaska A, Merks P. Challenges for Polish community pharmacists in provision of services to immigrants and non-Polish-speakers in 2018. Med Sci Monit 2021;27:e933678. doi: 10.12659/MSM.933678 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40. Zargarzadeh AH, Law AV. Access to multilingual prescription labels and verbal translation services in California. Res Social Adm Pharm 2011;7:338-46. doi: 10.1016/j.sapharm.2010.08.001 [DOI] [PubMed] [Google Scholar]
  • 41. Nakagawa S, Kume N. Pharmacy practice in Japan. Can J Hosp Pharm 2017;70:232-42. doi: 10.4212/cjhp.v70i3.1663 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42. Khoong EC, Steinbrook E, Brown C, Fernandez A. Assessing the use of Google Translate for Spanish and Chinese translations of emergency department discharge instructions. JAMA Intern Med 2019;179:580-2. doi: 10.1001/jamainternmed.2018.7653 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43. Horvat L, Horey D, Romios P, Kis-Rigo J. Cultural competence education for health professionals. Cochrane Database Syst Rev 2014;2014:CD009405. doi: 10.1002/14651858.CD009405.pub2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44. The University of Sydney. National Centre for Cultural Competence. What is cultural competence? 2016. Available: https://www.sydney.edu.au/nccc/about-us/what-is-cultural-competence.html?fbclid=IwAR2uKNNVIYjQcGP83n5Ny0P2touooAANCa3Apc_QdDzkVThKJ_I8knp2a-M (accessed Jul. 27, 2024).
  • 45. American College of Clinical Pharmacy, O’Connell MB, Korner EJ, Rickles NM, Sias JJ. Cultural competence in health care and its implications for pharmacy. Part 1. Overview of key concepts in multicultural health care. Pharmacotherapy 2007;27:1062-79. doi:10.1592/phco.27 .7.1062 [DOI] [PubMed] [Google Scholar]
  • 46. McCann J, Lau WM, Husband A, et al. ‘Creating a culturally competent pharmacy profession’: a qualitative exploration of pharmacy staff perspectives of cultural competence and its training in community pharmacy settings. Health Expect 2023;26:1941-53. doi: 10.1111/hex.13803 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47. Amin MEK. Addressing cultural competence and bias in treating migrant workers in pharmacies: pharmacy students learning and changing norms. Res Social Adm Pharm 2022;18:3362-8. doi: 10.1016/j.sapharm.2021.11.012 [DOI] [PubMed] [Google Scholar]
  • 48. United Nations Development Programme. What does it mean to leave no one behind? August 9, 2018. Available: https://www.undp.org/publications/what-does-it-mean-leave-no-one-behind (accessed Jul. 27, 2024).

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sj-pdf-1-cph-10.1177_17151635241305375 – Supplemental material for Pharmacist accessibility for non-native Japanese speakers: A cross-sectional study in Japan
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Supplemental material, sj-pdf-1-cph-10.1177_17151635241305375 for Pharmacist accessibility for non-native Japanese speakers: A cross-sectional study in Japan by Shota Suzuki, Yoshitaka Nishikawa, Takeo Nakayama and Hiroshi Okada in Canadian Pharmacists Journal / Revue des Pharmaciens du Canada

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