Demographics
WABI women (n=15) completed the interview. All the participants in the study had reported a diagnosis of HTN and had either a parent, grandparent or sibling with a history of HTN. As shown in the summary of selected demographic characteristics in Table 1, the mean age of participants was 47.5 years. A majority of the women (67%, n=10) were between 51-65 years of age. Their length of stay in the United States for the majority of the women (97%, n=14) was more than five years. Five of the women were less than 26 years of age when they came to the United States. Twelve of the women were born in Nigeria and Cameroun and three were born in Sierra Leone, Liberia, and Ghana. This was a highly educated sample; 14 of the 15 women had either college or post-college degree. Twelve of those with at least a college degree worked in a health-related profession. Thirteen of the women had either private or federal health insurance while two women had no health insurance.
Table 1.Participant Demographics
(n=15) Mean age 47.5
Variable
|
Category
|
N
|
%
|
|
Age
|
30-40 years
|
3
|
20
|
41-50 years
|
2
|
13
|
51-65 years
|
10
|
67
|
|
Age upon arrival to the United States
|
18-25 years
|
5
|
33
|
26-45 years
|
8
|
53
|
46-65 years
|
2
|
13
|
|
Country of Birth (West Africa)
|
Nigeria
|
7
|
47
|
Liberia
|
1
|
7
|
Cameroon
|
5
|
33
|
Sierra Leone
|
1
|
7
|
Ghana
|
1
|
7
|
|
State of Residence
|
Maryland
|
14
|
93
|
Washington DC
|
1
|
7
|
|
Length of Residence in the United States
|
Less than 5 years
|
1
|
7
|
More than 5 years
|
14
|
93
|
|
Level of Education
|
High School
|
1
|
7
|
College
|
8
|
53
|
Postgraduate
|
6
|
40
|
|
Insurance Status
|
Has Health Insurance
|
12
|
80
|
No Health Insurance
|
3
|
20
|
|
Occupation
|
Health Professional
|
12
|
80
|
Non-Health Professional
|
3
|
20
|
|
Experience with HCP and Utilization of HTN services
Table 2 shows the primary themes that described the women's perception of good utilization and access to HTN care and successful HTN health services that include health insurance coverage; interaction with HCP; frequency of health care visits; culturally congruent HCP and HTN self-care incentives. Many of the women had medical insurance but did not seek HTN health services primarily because they were dissatisfied with the quality of care and communication.
Table 2. Selected Research Questions and Primary Themes
Research Questions
|
Primary Themes
|
What is the experience of WABI women in accessing and utilizing healthcare for HTN
|
Health Insurance Coverage
|
Frequency of HTN Care Visits
|
Interaction with HCP
|
|
What do WABI women believe should be the components of successful HTN education programs or services?
|
Culturally Sensitive HCP
|
HTN Self-Care Incentives
|
|
Table 3 shows the main factors reported by participants related to their experiences accessing and using HTN health care services. Eighty percent of the women had health insurance and lived 10-30 minutes walking or driving distance to their HCP facility. Many of them chose their current HCP because of the convenient location of their clinics.
Eighty-seven percent had an HCP who could manage their HTN, but most reported accessing care primarily for annual checkups. About 53% of those with health insurance and regular HCP had utilized a hospital emergency room(ER) or Urgent Care in the past year. More than 60% of the women were either not satisfied with their overall care, or reported that clinicians did not listen to their concerns or provide culturally appropriate guidance during their visits.
Table 3. Factors relevant to accessing and utilizing hypertension health care services
Participant Number
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
11
|
12
|
13
|
14
|
15
|
n
|
Has health insurance
|
X
|
X
|
X
|
X
|
X
|
X
|
|
X
|
|
|
X
|
X
|
X
|
X
|
X
|
12
|
Difficulty with cardiologist appointment
|
X
|
X
|
|
|
|
X
|
X
|
|
X
|
X
|
|
|
|
|
X
|
7
|
Went to ER/urgent in past one year
|
X
|
X
|
|
|
X
|
X
|
|
X
|
X
|
X
|
|
|
|
|
X
|
8
|
Primary HCP treats HTN
|
X
|
X
|
X
|
X
|
X
|
X
|
|
|
X
|
X
|
X
|
X
|
X
|
X
|
X
|
13
|
Drives less than one hour to HCP visit
|
X
|
X
|
X
|
X
|
X
|
|
|
X
|
|
X
|
X
|
X
|
X
|
X
|
|
11
|
HCP listens and gives enough time during visit
|
|
|
X
|
X
|
X
|
|
|
|
|
|
|
X
|
X
|
|
|
5
|
Referred to a cardiologist in past one year
|
X
|
X
|
X
|
|
|
|
|
|
|
|
|
|
|
|
X
|
4
|
Satisfied with current HTN provider care
|
|
|
X
|
X
|
X
|
X
|
|
|
X
|
X
|
|
X
|
X
|
|
X
|
9
|
Satisfied with overall HTN care
|
|
|
X
|
X
|
X
|
|
|
|
|
|
|
X
|
X
|
|
|
5
|
Access and Utilization of HTN services
Theme 1:Negative Experience with Health Care Providers and Poor Quality of Care
Subtheme 1. HCPs do not listen, spend enough time, or give attention. All the women thought it is necessary to see a HCP routinely for HTN checkup and to see a cardiologist at least once a year but felt disconnected from their HCP during visits, and subsequently went to the ER for HTN care. Many of the women including a physician said their previous and current HCPs were too busy and would not listen or interact with them when they voiced their concerns. Many reported that their HCP rushed and were in a hurry during their visits. One of the women said:
“I stopped seeing doctors for HTN; it is only if I go to the ER for other things that they check my BP.“I have noticed that lately maybe in the last 2 years my doctor has become very busy and had less time to listen to my concerns; I feel providers don't have enough time to sit to listen to what the patient is experiencing.”
Another participant said that she was not able to speak up when discussing her HTN care with HCP.“She believes that HCP should initiate an interactive discussion during visit. “I believe one should be allowed to speak up when you have a question.”Similarly, another woman expressed her dissatisfaction with HCP‘s lack of eye contact during her visit. The woman reported that she cancelled her subsequent appointments with that HCP because during her last visit, the HCP focused on the computer screen as she said: “It looks like you are ‘shrinking’ Shrinking is a medical jargon HCP use at times in reference to a reduction in a patient’s Body Mass Index calculated with the patient weight and height which participant did not understand because the HCP could not clarify.
Subtheme 2. Medications don’t work. In further description of access to HCP, one participant did not keep many of her HTN check-up appointments and expressed that HCP did not pay attention to her personal health behaviors before prescribing BP medications that did not help in controlling their BP.
“I only went to my doctor because she may not continue to refill my prescription. I was taking hibiscus tea with glucosamine/chondroitin but could not share this with my doctor as she was not open to listening to me.”
Another participant expressed similar experience with HCP visit: The whole goal when you see the doctors are to put you on medications that do not work.’’“They want to do the quick fix like give another prescription.’’
Theme 2: Components and Improvement of Hypertension Program and Services
Subtheme 3. Need for more interactive and culturally sensitive care. Many of the women valued culturally sensitive providers that are willing to have a dialogue with them regarding their test results and BP readings. The women preferred culturally competent HCP that asked for their input and feedback in treatment decision making and development of the plan of care.They wished to have alternative dietary recommendations with African cultural appeal instead of the Dietary Approach to Stop Hypertension (DASH) diet with American food examples that WABI women may not enjoy cooking or eating. For example, one of the women expressed her experience with a HCP that asked if she was on a DASH diet and recommended:
“Ask me about the food I like first not just saying DASH diet. Ask me if for example, I eat cassava leaves; do not put too many coconut oil or peanut butter. Look at my foods and see if I can adjust it.”
Subtheme 4. Better education, training, communication and consideration of ethnic preferences. Many of the women valued health education, quick feedback, a shared decision-making approach, and provision of personalized care. One of the participants said a quality program should have HCPs that can educate patients on alternative HTN treatment remedies:
“For example, I googled ‘what happens when you take hibiscus tea and glucosamine supplement’, and found out that you cannot take hibiscus tea with anything that has Motrin or any medicine for inflammation as it increases BP. I had to google it, but a HCP should discuss this.”
Two of the women thought an ideal HTN program is good interaction and engaging communication between patients, their nurse and doctors. One said:“A place where HCP listen and communicate well with patients and open to answer their questions and encourage them to take responsibility for their health.”The other reported: “This is not my country I came here I did not know much about this BP so I prefer a doctor that can listen to me and educate me about this illness."
Two women made suggestions regarding having HTN programs with staff who understand WABI culture and beliefs. “Doctors with experience in tropical medicine or had worked or lived in West-Africa would be very appropriate and ideal." “I would like a program that would first assess my background”