Racial and ethnic minorities

  Population considerations:

  • Access to health care. Racial and ethnic minority groups are less likely to have adequate health insurance (Kaiser, 2007). In addition, some racial and ethnic minority communities may not have access to primary care (LeNoir, 1999; Lopez, 2002).   As a result, they may seek care in acute care facilities or in emergency rooms.  Racial and ethnic minority groups are also less likely have regular contact with their health care provider (LeNoir, 1999). Individuals without a regular health care provider may have asthma symptoms that go unrecognized and undiagnosed.  These issues make it difficult to develop action plans to address future asthma symptoms or can hinder individuals’ ability to obtain asthma medications and supplies.
  • Stress. Racial and ethnic minorities may face life stressors, such as discrimination, violence and poverty.  Higher levels of stress often can trigger asthma episodes (Wright, 2001).
  • Environment.Racial and ethnic minority populations may live in environments with increased risk for asthma (e.g., environments with dust or pollutants) (LeNoir, 1999). 
  • Language. Language and cultural differences may affect the accessibility and quality of healthcare. It has been found that limited English proficiency may lead to under-diagnosis (Mosnaim, 2007).

  Strategies to address these considerations:

  • Involve the priority populations: It is important that individuals who are from the priority populations and are both bi-lingual and bi-cultural take an active role in planning, implementing and evaluating asthma interventions.
  • Engage community stakeholders: Leadership and active participation by community members, especially health care providers and religious leaders, can strengthen the credibility of and respect for the intervention.  Programs that had close ties to the communities they were attempting to assist were more likely to report a positive impact on health care utilization outcomes (CMCD, 2007).
  • Provide cultural competency training: Strategies to reach racial and ethnic minority populations should be culturally relevant (NCCC). It may be useful to provide training in cultural competency to individuals who are working with a community so that they can learn more about the differences within and across communities and how these differences influence asthma intervention design and implementation. See Cultural Competence for more information.
  • Tailor to culture: Interventions tailored to reflect the culture of a population subgroup may be more effective than those aimed at the general population (Bailey, 2008).  This may mean taking the following characteristics into consideration when designing asthma intervention components, materials and incentives: the community’s first language, common phrases and terms used by the community and visual imagery (e.g., photos, colors and symbols) that represents the community and their experience.
  • Provide skills training: Since minorities may be more likely to receive their asthma treatment in acute care facilities, providers in these settings should be encouraged to provide day-to-day asthma management education.
  • Advocate for change. One way to address asthma triggers is to advocate for changes in the environments in which people live, work and go to school.  For example, a community group may advocate for improved housing or smoking bans.
  • Incorporate relaxation techniques. In order to address stress, it may be useful to include relaxation techniques (e.g., progressive muscle relaxation, yoga, guided imagery, breath focus, meditation) as part of the intervention.
  • Increase access. It may be useful to identify mechanisms to enable intervention participants to access low-cost medications and supplies (e.g., peak flow meters, controller and reliever medications). 

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