Hypertension is more prevalent among African-Americans than Caucasians and poor medication adherence can cause potential complications including cardiovascular, cerebrovascular, or renal disease. Culture influences patients’ response to recommended treatments and medication adherence. An understanding of a patient’s culture, integrated with the healthcare provider’s culturally appropriate interventions, can promote improved adherence and patient outcomes.
It is important that providers do not stereotype or have a “one size fits all” attitude caring for a specific culture. Recognizing the uniqueness of each culture and tailoring the treatment plan to fit the patient’s needs may provide a satisfying outcome to both patient and provider.
Leading Health Complaint
Hypertension or high blood pressure is a chronic cardiovascular disease that contributes to significant morbidity and mortality in African-Americans. The disease burden greatly affects the African-American population disproportionately. In the United States, about 77.9 million (1 out of every 3) adults have high blood pressure. African-Americans develop high blood pressure more often, and at an earlier age, than Caucasians and Hispanics.
Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure and death if not detected early and treated appropriately. In 2010, the mortality rate was over 360,000 American deaths with high blood pressure as a contributing factor. According to the World Health Organization (WHO), hypertension contributes to 9.4 million deaths worldwide every year. Statistics have proven that about seven of every 10 people that have their first heart attack or eight out of every 10 people that have their first stroke have high blood pressure. Lifestyle modification is necessary for prevention of hypertension. It includes weight loss, smoking cessation, limiting alcohol intake, reducing sodium intake, maintaining adequate intake of dietary potassium, calcium and magnesium, reducing saturated fat and cholesterol intake and engaging in aerobic exercise at least 30 minutes daily.
The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNCC) recommends patients aged 60 years or older with a blood pressure of 150/90 or greater and for patients younger than 60 years with a blood pressure of 140/90 or greater be treated with antihypertensive medications.
Cultural Influence on Self-Care
Culture influences the way patients with hypertension maintain their health and how they adhere to medication regimens. When interacting with patients, nurses and other healthcare providers should be prepared to provide culturally sensitive education pertaining to hypertension. African-Americans have health and illness beliefs, practices and values and are at a greater risk for many diseases, especially those associated with a low income, stressful life, lack of access to primary care and negating health behaviors.
Providers should be mindful that African-Americans with low socioeconomic backgrounds have risk factors including tobacco, alcohol, drug use and other chronic diseases such as diabetes mellitus, hypercholesteremia and obesity associated with their hypertension. Healthy lifestyle may not take precedence for some African-Americans living in the inner cities. They often have to concentrate on daily survival skills, including food, shelter, and safety as well as living in neighborhoods that are surrounded by high fat, high sodium fast food restaurants that are easily accessible. African-Americans’ diets may be typically high in fat, cholesterol, and sodium, in which the meals are often fried or barbequed. Exercise may not be possible because patients may be fearful of walking in their neighborhoods because of high crime and unsafe environments.
Medication adherence also is imperative but African-American patients often fail to comply with their treatment regimen because of absence of symptoms of the disease, minimal knowledge about the disease, denial of the problem, medications are too expensive, difficulty with the regimen, actual or perceived unpleasant side effects of the medication, erectile dysfunction, mistrust in the healthcare system and uncertainty that the plan will improve their health. Other barriers may include the healthcare provider’s lack of cultural competence and sensitivity in understanding the African-Americans’ cultural health beliefs. Cultural beliefs, religious practices, and lifestyle of African-Americans may interfere with hypertension treatment regimen because they may choose to use homeopathic medication such as garlic pills, vitamins, or herbs in place of prescribed medications.
Community-Based Interventions
Linguistically and culturally appropriate interventional programs may help promote adherence to the treatment plan. Programs that can be implemented at work include nutritional classes, weight loss programs and exercise classes to motivate the patient towards healthy behaviors. The provider can also suggest prayer, which may help allay fears, decrease physical and emotional stress and reduce blood pressure.
SEE ALSO: Earn CE: Hypertension
Further interventions could include educating the community about hypertension, through their local barber shop or church. The barber shop is not only a place to get a haircut but it is also a social gathering for African-American men to offer and get support and encouragement. Providers can conduct a health fair in the church to promote wellness and education and can offer to speak to their congregants.
Culture plays a pivotal role in patients’ health behaviors and medication adherence. Healthcare professionals need to be familiar with the patient’s cultural beliefs and assess the patient’s likelihood of adhering to medications. A cultural assessment coupled with a cultural competence-training program may assist healthcare providers and patients with a mutually agreed on culturally appropriate treatment plan. Mandatory education on cultural competence should be a requirement for healthcare providers. If providers have a clearer understanding of African-Americans’ culture and integrate the beliefs into the treatment plan, the needs of this population can be met, and medication adherence may improve.
Andrea Brown works at Montefiore Medical Center in New York.
