psy 309 final paper2

Running head: CULTURALLY ADAPTED HYPERTENSION EDUCATION 1

Culturally Adapted Hypertension Education to the Hispanic and African-American Communities

as a Means of Prevention

Gina Ferrara

Alvernia University

CULTURALLY ADAPTED HYPERTENSION EDUCATION 2

Abstract

The study discussed has been designed to teach prevalent populations, specifically

Hispanic and African immigrants, with hypertension about it and give them the knowledge base

to lower their blood pressure through lifestyle modifications. The participants for the study will

be people between the ages of thirty and fifty who have moved to the United States within the

last year and have previously been diagnosed with hypertension and do not have diabetes. The

study that has been conducted involves a control and experimental group for each of the two

cultures. The experimental and control groups will both be given the same pretest and posttest.

However, the experimental groups will receive the culturally appropriate teaching in regard to

hypertension while the control groups will not. After the completion of the study the control

group will receive the teaching the experimental group received. The hypothesis that has been

developed for this study is that culturally appropriate hypertension education will enable the

participants in the experimental group to have a higher knowledge base on how to decrease their

blood pressure and will in turn have a bigger decrease in blood pressure, Low Density

Lipoprotein cholesterol, and Body Mass Index than those in the control group that have not had

any teaching. This hypothesis was supported by the research findings.


Introduction

Health education, learning experiences designed to help individuals and communities, is

essential for all people to be knowledgeable about to benefit their health. A common health

concern in America is hypertension, or high blood pressure. This is most prevalent in the

Hispanic and African-American cultures. Most people in these cultures have poor literacy skills

and knowledge on the preventability of this condition. By teaching both of these cultures in

terms and languages that they will understand it will prove to be beneficial to their health and,

based on their choices, lower their blood pressure.

Literature Review

The literature that was found for this study was in regards to culturally sensitive health

interventions, health education strategies for immigrants, and community understandings on

health condition preventability. The research that was found discussed the populations in relation

to the proposed study. This includes the African origin population and the control and treatment

of their hypertension, the Hispanic population, and the immigrant population. A majority of the

articles found were helpful in either talking about the effectiveness of culturally appropriate

interventions and the barriers that these populations will have to learning.

The research found was very beneficial to this study. In a study done in regards to

culturally adapted hypertension education, it required the participants to meet the eligibility

criteria of being “aged 20 or older, having a diagnosis of HTN [Hypertension] based on the

International Classification of Primary care…and having SBP [Systolic Blood Pressure] ≥ 140

mmHg at the last office visit. Patients were excluded if they had type 1 or type 2 diabetes, since

diabetes requires additional care” (Beune). The eligibility criteria mentioned in this study was

modeled after in this study. Another article measured the health literacy of a community and their


knowledge of the preventability of diseases including hypertension. It was found that “those

respondents with lower levels of education, or those who were not born in an English speaking

country, were less likely to recognize a number of health conditions as preventable” (Moore).

This very much relates to the population of participants I am targeting with this study.

In regards to the barriers that are faced by the non-English speaking population, “learning

to navigate our increasingly complex health care system presents a significant challenge itself

and serves as a barrier to receiving care. Many Latinos who are able to access health services still

face the challenge of linguistic barriers when interacting with the mainstream US healthcare

system” (Harvey). The article continues to address the issue of Latinos not being able to

communicate with their healthcare providers and ancillary staff. Translation services are often

provided by hospitals and clinics but rarely provide written patient information in Spanish that is

culturally appropriate.

In the African-American population there are also many barriers to their learning. This

population has a history of being discriminated against which causes them to have a culture of

distrust toward whites. A fear of continued discrimination hinders them from expressing private

information. Other barriers that have been discussed in the research include limited literacy, the

extent that individuals identify with their racial and ethnic group, body image ideals, the

centrality of women, and their socioeconomic status. In the African-American culture families

are women-centered and are the heads of households with respected and influential roles in the

family, religious, and civic networks. One of the articles brings up the point that “family

members’ eating habits are influenced by the eating habits of the person who prepares the

majority of the family’s meals, targeting women in this position may therefore be benefit other

household members” (DiNoia). This a very relevant point to this study. Nutrition and diet affect a


person’s health status and it is important to understand the structure of the African-American

culture to tailor learning to them.

The immigrant population in North America was also examined for barriers to learning

that would need to be addressed. “Promoting health in immigrant populations is difficult due to

cultural, linguistic, health literacy and socio-economic barriers. Cultural sensitivity, careful

inquiry and comprehensive knowledge of immigrants’ social circumstances are essential to every

health education programme” (Zou). It has also been found through the research that “the use of

bi-lingual community health workers can promote greater uptake of disease prevention strategies

by CALD [Culturally And Linguistically Diverse] communities” (Henderson).

In a study done in regards to culturally sensitive health counseling as a means of

prevention of lifestyle-related disease in Japan, five methods for providing culturally sensitive

counseling were identified. The first was “showing an interest in, and respect for, the local

culture” the second is “stimulating the participants’ awareness of the health risks inherited in

their local cultural practices through the use of familiar examples” the third is “accepting and

understanding the participants’ ambivalence about their local culture” the fourth is “connecting

the reasons for the participants to change their lifestyle with their local culture”, and the fifth and

final one is “adjusting the health-promoting behaviors of the participants to fit their local culture”

(Marutani).

Methods

Culturally appropriate hypertension teachings to Hispanic and African immigrants is the

focus of this study. Hypertension is diagnosed after blood pressure readings over multiple

occasions are above 140/90 mmHg. Normal blood pressure is defined as less than 120 over less

than 80mmHg. Prehypertension is between 120-139/80-89mmHg. Stage 1 hypertension is


between 140-159/90-99mmHg and stage 2 hypertension is greater than 160/100mmHg.

This study will be examining the effectiveness of culturally adapted hypertension

education on populations that are most prone to high blood pressure and will last for a month.

The two different populations that will be examined in this study are immigrant Mexicans and

immigrants from African countries. They will be contacted through English as a Second

Language classes. Those that agree to participate in the study will first be asked if they have

previously been told that they have high blood pressure and if they are on any medications for it,

have diabetes, and their ability to navigate the health care system. The study is looking for

participants to be of either gender and be between the ages of thirty five and fifty. They need to

have been diagnosed with hypertension by a previous health care provider and not be on any

medications for treatment of it or be a diabetic. It is also essential that these people have moved

to the United States within the last year from a Hispanic country like Mexico or an African

nation.

Once the participants have been established they will be divided into experimental and

control groups. There will be an experimental group and a control group for each culture being

examined. Each group will have a pretest with questions in regards to previous teachings they

had been given about their hypertension, any lifestyle changes that they have made since

diagnosis, and if they feel they understand what hypertension is. They will also be taught how to

navigate the health care system in the United States. These will be weekly teaching sessions

following their ESL class to make it more convenient for them to remain in the study. Their

blood pressure will also be taken at this time as well as blood work to check their cholesterol

levels, and their height and weight to check their Body Mass Index. The pretests will be given in

either their native language or English. The participants having been from an English as a


Second Language class, they will be offered to take the pretest in English or their native

language so they fully understand the survey.

The experimental groups of both cultures will then be given culturally appropriate

teaching sessions about hypertension. They will be taught by a trained health care professional

that is of their culture and relatable for them. It has been found in the research that “immigrants

often resist the dominant western biomedical model because of different cultural beliefs and

traditional health practices. Some immigrants come from countries where there are elaborate

systems of traditional medicine and beliefs about health and disease” (Zou). It is then essential

for the health care professionals conducting the teaching sessions to be considerate of the cultural

practices and beliefs of health and incorporate that into their teachings. The teachings will

include topics on the causes of hypertension, nutrition, exercise, and stress reduction. They will

also be taught in their native language and in simple terms.

A posttest which will be similar to the pretest, will then follow the weekly teaching

sessions and be given to both groups. This will ask the participants if they received any teaching

about their hypertension diagnosis, if they feel more comfortable with what the term means and

how to seek medical help. Their blood pressures will also be taken, as well as cholesterol levels

being measured through blood work, and their height and weight being taken again for their

Body Mass Index. Following the posttest the control group of each culture will then be given the

teaching so that no one leaves the study without having been taught about their hypertension.

The question I have developed my research on is, does health education on hypertension

when culturally adapted to the Hispanic and African-American populations help improve the

health status of those that already have it? The independent variable of this study is the culture

that is being addressed and the dependent variable is the teaching that is being changed to meet


the needs of each culture. The hypothesis for this study is that culturally appropriate hypertension

education will enable the participants in the experimental group to have a higher knowledge base

on how to decrease their blood pressure and will in turn have a bigger decrease in blood pressure,

Low Density Lipoprotein cholesterol, and Body Mass Index than those in the control group that

have not had any teaching.

Findings

Based on the research that has been discussed on this topic it is expected that the findings

would be in favor of my hypothesis. The participants in the experimental groups of the study are

expected to have a lowered blood pressure as a result of the teaching sessions and lifestyle

recommendations made by the health care professionals. According to Henderson “culturally

safe and competent services will translate into better health via the impact they have on:

improved communication channels; increased trust in the health system; greater knowledge

about health and services in CALD [Culturally And Linguistically Diverse] communities and

expanded cultural understanding within the health system” (Henderson). She also explains that

culturally appropriate and competent services will allow these people have better access to health

care without fear of discrimination and with respect to their health beliefs. She had also found

that for individuals in diverse communities participating in a blood pressure study proved that

“individual counselling and home visits showed significant improvement in appointment keeping

and blood pressure control after 12 months. This indicates that counselling and home visits may

be a better intervention for long-term sustainability in blood pressure control” (Henderson).

The use of community health workers that speak the native language of the participants is

expected to be beneficial to the health of the participants. As previously mentioned in the

Literature Review section, this will allow for participants, being immigrants, to be more


receptive to the teachings and open to the recommendations being presented. The blood pressure

readings of the control groups would be expected to decrease similarly to the experimental

groups if the participants have decreased stress levels or made lifestyle changes or that the

teachings and blood pressure monitoring were not over a long enough period of time to show

substantial results.

It is also expected that there will be a low percentage of drop outs from this study.

According to Zou, immigrants “have low motivation to attend health education and assume self-

care responsibility. Immigrants often resist the dominant western biomedical model because of

different cultural beliefs and traditional health practices. Some immigrants come from countries

where there are elaborate systems of traditional medicine and beliefs about health and disease”

(Zou). If this were to become the case with this study this may be the cause of the dropouts.

Conclusion

The goal of this study was to develop a culturally appropriate method of teaching

immigrants how to take better care of their health, specifically their blood pressure. This was

obtained via the findings presented. My hypothesis was supported by the research found granted

that the teachings be covered by the community health workers remain inclusive to the two

different cultural groups.


References

Beune, E. J., Moll van Charante, E. P., Beem, L., Mohrs, J., Agyemang, C. O., Ogedegbe, G., &

Haafkens, J. A. (2014). Culturally Adapted Hypertension Education (CAHE) to Improve Blood

Pressure Control and Treatment Adherence in Patients of African Origin with Uncontrolled

Hypertension: Cluster-Randomized Trial. Plos ONE, 9(3), 1-11.

doi:10.1371/journal.pone.0090103

Di Noia, J., Furst, G., Park, K., & Byrd-Bredbenner, C. (2013). Designing culturally sensitive dietary

interventions for African Americans: review and recommendations. Nutrition Reviews,71(4),

224-238. doi:10.1111/nure.12009

Harvey, I., & O'Brien, M. (2011). Addressing Health Disparities Through Patient Education: The

Development of Culturally-Tailored Health Education Materials at Puentes de Salud. Journal Of

Community Health Nursing, 28(4), 181-189. doi:10.1080/07370016.2011.614827

Henderson, S., Kendall, E., & See, L. (2011). The effectiveness of culturally appropriate interventions to

manage or prevent chronic disease in culturally and linguistically diverse communities: a

systematic literature review. Health & Social Care In The Community, 19(3), 225-249.

doi:10.1111/j.1365-2524.2010.00972

Marutani, M., & Miyazaki, M. (2010). Culturally sensitive health counseling to prevent lifestyle-related

diseases in Japan. Nursing & Health Sciences, 12(3), 392-398. doi:10.1111/j.1442-

2018.2010.00544

Moore, K., Smith, B. J., & Reilly, K. (2013). Community understanding of the preventability of major

health conditions as a measure of health literacy. Australian Journal of Rural Health, 21(1), 35-

40. doi:10.1111/ajr.12005

Zou, P., & Parry, M. (2012). Strategies for health education in North American immigrant


populations. International Nursing Review,59(4), 482-488. doi:10.1111/j.1466-7657.2012.01021.


Appendix A: Pretest

1. Have you ever been told you have high blood pressure/hypertension? ___________

2. If known, what is your typical blood pressure reading?_______/_______

3. On a scale of one to five with five being the most comfortable. How comfortable are you with

scheduling a doctor’s appointment?_____


filing out doctor’s office forms?_____

5. Do you smoke or have you ever smoked?_____

6. Have you been told you have high cholesterol?____

7. On a scale of one to five with five being the most knowledgeable. How knowledgeable do you

feel you are about high blood pressure?_____

8. Have you ever been taught about high blood pressure or how to prevent it?______

9. If yes, where were you taught this?____________________________________


Appendix B: Posttest

1. Have you ever been told you have high blood pressure/hypertension? ___________

2. If known, what is your typical blood pressure reading?_______/_______


scheduling a doctor’s appointment?_____


filing out doctor’s office forms?_____

5. Do you smoke or have you ever smoked?_____

6. Have you been told you have high cholesterol?____

7. On a scale of one to five with five being the most knowledgeable. How knowledgeable do you

feel you are about high blood pressure?_____

8. Have you ever been taught about high blood pressure or how to prevent it?______

9. If yes, where were you taught this?____________________________________

psy 309 final paper2

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