Pilot study evaluating the effects of an intervention to enhance culturally appropriate hypertension education among healthcare providers in a primary care setting (original) (raw)
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PLOS ONE, 2017
Background In Western countries, hypertension and hypertension-related complication are more common in ethnic minority groups of African descent than in indigenous populations. Addressing ethnic minority patients' perceptions of hypertension and its treatment through the use of cultural appropriate hypertension education (CAHE) increases adherence to medication and lifestyle recommendations. Given these effects, it seems warranted to develop a training program on how to deliver this type of patient education for Primary Care Nurse Practitioners (PCNPs). Objective Development and evaluation of a training program for PCNPs aimed at providing culturally appropriate hypertension patient education. Design Prospective cohort study evaluating attitude and intended behavioral changes. Participants Both experienced PCNPs and PCNPs in training participated in this study. Main measures The effects of the CAHE-training were measured by 3 different questionnaires on 1) the satisfaction with the training program, 2) the attitude towards culturally appropriate care, and 3) the commitment to change.
Hypertension Management in Minority Communities: A Clinician Survey
Journal of General Internal Medicine, 2007
BACKGROUND: Rates of blood pressure (BP) control are lower in minority populations compared to whites. OBJECTIVE: As part of a project to decrease healthrelated disparities among ethnic groups, we sought to evaluate the knowledge, attitudes, and management practices of clinicians caring for hypertensive patients in a predominantly minority community. DESIGN/PARTICIPANTS: We developed clinical vignettes of hypertensive patients that varied by comorbidity (type II diabetes mellitus, chronic renal insufficiency, coronary artery disease, or isolated systolic hypertension alone). We randomly assigned patient characteristics, e.g., gender, age, race/ethnicity, to each vignette. We surveyed clinicians in ambulatory clinics of the 4 hospitals in East/ Central Harlem, NY. MEASUREMENTS: The analysis used national guidelines to assess the appropriateness of clinicians' stated target BP levels. We also assessed clinicians' attitudes about the likelihood of each patient to achieve adequate BP control, adhere to medications, and return for follow-up. RESULTS: Clinicians' target BPs were within 2 mm Hg of the recommendations 9% of the time for renal disease patients, 86% for diabetes, 94% for isolated systolic hypertension, and 99% for coronary disease. BP targets did not vary by patient or clinician characteristics. Clinicians rated African-American patients 8.4% (p=.004) less likely and non-English speaking Hispanic patients 8.1% (p=.051) less likely than white patients to achieve/maintain BP control. CONCLUSIONS: Clinicians demonstrated adequate knowledge of recommended BP targets, except for patients with renal disease. Clinicians did not vary management by patients' sociodemographics but thought African-American, non-English-speaking Hispanic and unemployed patients were less likely to achieve BP control than their white counterparts.
Provider and clinic cultural competence in a primary care setting
Social Science & Medicine, 2008
A multilevel approach that enhances the cultural competence of clinicians and healthcare systems is suggested as one solution to reducing racial/ethnic disparities in healthcare. The primary objective of this cross-sectional study was to determine if there is a relationship between the cultural competence of primary care providers and the clinics where they work. Forty-nine providers from 23 clinics in Baltimore, Maryland and Wilmington, Delaware, USA. completed an on-line survey which included items assessing provider and clinic cultural competence. Using simple linear regression, it was found that providers with attitudes reflecting greater cultural motivation to learn were more likely to work in clinics with a higher percent of nonwhite staff, and those offering cultural diversity training and culturally adapted patient education materials. More culturally appropriate provider behavior was associated with a higher percent of nonwhite staff in the clinic, and culturally adapted patient education materials. Enhancing provider and clinic cultural competence may be synergistic strategies for reducing healthcare disparities.
Implementation Science, 2009
Background: North American Chinese women have lower levels of Papanicolaou (Pap) testing than other population subgroups. We conducted a randomized controlled trial to evaluate the effectiveness of two alternative cervical cancer screening interventions for Chinese women living in North America. Methods: Four hundred and eighty-two Pap testing underutilizers were identified from community-based surveys of Chinese women conducted in Seattle, Washington, and Vancouver, British Columbia. These women were randomly assigned to one of two experimental arms or control status. Several Chinese-language materials were used in both experimental arms: an education-entertainment video, a motivational pamphlet, an educational brochure, and a fact sheet. Women in the first experimental group (outreach worker intervention) received the materials, as well as tailored counseling and logistic assistance, during home visits by trilingual, bicultural outreach workers. Those in the second experimental group (direct mail intervention) received the materials by mail. The control group received usual care. Follow-up surveys were completed 6 months after randomization to ascertain participants' Pap testing behavior. All statistical tests were two-sided. Results: A total of 402 women responded to the follow-up survey (83% response rate). Of these women, 50 (39%) of the 129 women in the outreach group, 35 (25%) of the 139 women in the direct mail group, and 20 (15%) of the 134 women in the control group reported Pap testing in the interval between randomization and follow-up data collection (P<.001 for outreach worker versus control, P = .03 for direct mail versus control, and P = .02 for outreach worker versus direct mail). Intervention effects were greater in Vancouver than in Seattle. Conclusion: Culturally and linguistically appropriate interventions may improve Pap testing levels among Chinese women in
2021
Objective: To review methods that could contribute to improved knowledge of hypertension among African immigrants at a California congregation. The difference in the management and outcomes of hypertension between African Americans and Whites is most disparate in cardiovascular disease, with lack of education documented as a major contributor for African Americans (Lackland, 2014) and African immigrants (Turson-Ocran et al., 2020). African Americans differ slightly in culture, health, and migration history from Africans who are 21st century immigrants from Africa (African immigrants); however, there are more similarities than differences between them (Terrazas, 2009). This brief report will describe a Doctor of Nursing Practice project to address lack of hypertension knowledge among African immigrants. Design: This project will utilize a focus group approach; and pre and post survey tools to assess and evaluate knowledge. Setting: A church in Southern California of about 150 congregants. Participants: Twenty adult African immigrants diagnosed with or self-reported hypertension. Methods: As part of African culture, storytelling will be utilized in the delivery of hypertension education. Pre-and post-intervention surveys will be used to assess and evaluate knowledge. Results: Participants will report knowledge and consequences of uncontrolled hypertension before and after the education. Conclusion: Findings may demonstrate the importance of evidence-based hypertension education among African immigrants in a culturally important setting like a church, identify barriers and facilitators of hypertension self-management, and may suggest a need for redesign of hypertension education strategies in African immigrants, such as storytelling which considers the importance of culture in health.
Ethnic/Racial Variations in Blood Pressure Awareness, Treatment, and Control
The Journal of Clinical Hypertension, 2007
step to developing interventions to improve cardiovascular health. The National Health and Nutrition Examination Survey (NHANES) 1999-2002 was used to identify predictors of hypertension awareness, treatment, and control. An estimated 63.3 million (31.0%) US adults currently have BP exceeding 140/90 mm Hg, and prevalence is higher for blacks than for other racial/ethnic subgroups. Among antihypertensive medication-treated patients, 51.3% are controlled. Treated blacks and Mexican Americans have the lowest rates of BP control. Mexican Americans are 0.62 times as likely to be aware and 0.61 times as likely to be treated as white persons with hypertension. Compared with whites, treated Mexican Americans are 0.71 times as likely and treated blacks 0.59 times as likely to achieve BP control. Hypertension treatment and BP control in the United States remain suboptimal, and significant racial/ethnic disparities persist. Effective interventions targeting Mexican Americans and blacks as well as whites are essential to improving hypertension management. (J Clin Hypertens. 2007;9:345-354)
Implementation Science, 2013
Background: Racial disparities in blood pressure control have been well documented in the United States. Research suggests that many factors contribute to this disparity, including barriers to care at patient, clinician, healthcare system, and community levels. To date, few interventions aimed at reducing hypertension disparities have addressed factors at all of these levels. This paper describes the design of Project ReD CHiP (Reducing Disparities and Controlling Hypertension in Primary Care), a multi-level system quality improvement project. By intervening on multiple levels, this project aims to reduce disparities in blood pressure control and improve guideline concordant hypertension care.