Overcome Cross-Cultural Barriers to Properly Treat Hypertension Among Minorities

ORLANDO—Minorities are disproportionately affected by cardiovascular disease (CVD) and its risk factors, including hypertension. However, due to cross-cultural barriers, minorities often do not receive the necessary hypertension care. During his presentation at today’s Consultant360’s Cardiometabolic Risk Summit 2019, Alexander R. Green, MD, outlined the barriers to proper hypertension management that minorities face and how to overcome them.

Communication Barriers

According to Dr Green, language is a main barrier to minorities receiving the proper care. Compared with white individuals, African American, Hispanic, and Asian Americans all report having a more difficult time communicating with physicians and may be less likely to ask questions.

According to Dr Green, the percentage of individuals in the United States who have Limited English Proficiency has increased from 8.5% to 10.0% over the past decade. Among patients who have Limited English Proficiency, 49% to 55% utilize interpreter services. 

To address the language barrier, Dr Green suggests that providers work with qualified interpreters and review interpreting guidelines.

Another communication barrier relates to literacy, with more than half of US adults having limited functional health literacy. Dr Green stressed that clinicians should not assume that a patient is literate and to use simple terminology, videos, and pictorial diagrams when communicating with patients.

Lack of Trust

Compared with whites, blacks and Latinos are more likely to have mistrust in the heath care system. To overcome this barrier, the first step is to identify which patients have that mistrust and address it tactfully. Once that has been done, Dr Green suggested that practitioners establish trust by focusing on their own nonverbal communication skills, building a personal connection with the patient, and reassuring the patient of specific concerns. 

Differing Perspectives

Hypertension is perceived differently by individuals in the biomedical community and by the majority of patients. And according to Dr Green, individuals in the cross-cultural patient population have an even different perspective on hypertension. 

To better understand minorities’ perspective on the condition and to gain insight on their health beliefs, values, and alternative practices, Dr Green suggests asking open-ended questions such as, “What does it mean for you to have hypertension?” and “Does anyone else you know have hypertension?” When having these discussions with patients, using normalizing statements is imperative. 

Psychosocial/Financial Barriers

Similar to overcoming barriers relating to perspective, when addressing patients’ psychosocial and financial concerns, practitioners should also use normalizing statements and ask open-ended questions like, “Have you had any trouble getting your medications?” and “How important is treating your hypertension for you compared with other issues that you are dealing with?” The answers to these questions may shed light on why a patient is not adhering to their treatment.

Regardless of what the barrier to proper hypertension management is, negotiation is key, Dr Green said. The patient and clinician must come to a mutual understanding and have improved cooperation.

—Colleen Murphy

Reference:

Green AR. Cultural competence in the management of hypertension. Talk presented at: Consultant360’s Cardiometabolic Risk Summit 2019; October 24-26, 2019; Orlando, FL.