Racial and ethnic minorities

  Population considerations

  • Awareness of symptoms. In racial and ethnic minority populations, awareness of heart attack and stroke symptoms may be lower than that of the general population (DuBard, 2006).
  • Access to health care. Racial and ethnic minority groups are less likely to have regular contact with a health care provider (Smith, 2003; Hargraves, 2003; Edwards, 1995). Individuals without a regular health care provider may have symptoms that go unrecognized and undiagnosed.  As a result, minorities may be less likely to receive recommendations to prevent or treat heart disease and stroke (Yancy, 2004). Racial and ethnic minorities are less likely to have their blood pressure checked, and they are more limited in their choice for health care (Shaya, 2006). Likewise, minority communities may be less likely to have access to the same range of medical treatments as the general population (Gornick, 1996; Carlisle, 1997; Nelson, 2002).
  • Access to resources. Neighborhoods where minorities live typically have more fast-food restaurants and fewer vendors of healthful foods than do predominantly white neighborhoods. They also face obstacles to physical activity such as unsafe streets, dilapidated parks and interpersonal crime (Kumanyika, 2006).
  • Health insurance. Racial and ethnic minorities are less likely to have adequate health insurance (Kaiser, 2007). As a result, they may seek care in acute care facilities or in emergency rooms.  Individuals without a regular health care provider may have symptoms that go unrecognized and undiagnosed, and may not receive recommendations to prevent or treat heart disease and stroke (Yancy, 2004).
  • Cultural Incompetence: Poor cultural competence in dealing with minority populations can have adverse outcomes, including decreased satisfaction with care, increased medical errors, difficulties obtaining informed consent, decrease in prescriptions and increase in the use of unproven remedies (Davidson, 2007).
  • Education and Language: Some racial and ethnic minority communities may have low levels of formal education or literacy, which can hinder patient comprehension of the health consequences of heart disease and stroke (Shaya, 2006). Studies have demonstrated that language barriers and the inability to comprehend the provider’s treatment plans can lead to poor compliance and underuse of services (Penchansky, 1981). There is a growing body of evidence to suggest that those with low English proficiency experience greater barriers to care, worse quality of care and worse health outcomes than the general population (DuBard, 2006).
  • Stress. Ethnic and racial minorities may face life stressors, such as discrimination, violence and poverty.  Higher levels of stress often can contribute to unhealthy lifestyles, including sedentary behaviors, poor nutrition and tobacco use (Edwards, 1995).
  • Trust. African Americans may have a general mistrust of the medical system due to experiences of discrimination and abuses that occurred in past medical research (Taylor, 2005). Likewise, Hispanics and Latinos may have less trust in physicians and hospitals than the general population (Morgenstern, 2001).
  • Misconceptions. In the past, concerns about heart disease and stroke among Latino and Hispanic subjects in the United States were muted by widespread perceptions that they were less susceptible than the general population.  This perception, known as the “Hispanic paradox” slowed the response of the medical community to the problem presented by heart disease and stroke among the Hispanic-Latino population (Davidson, 2007).

  Strategies to address racial/ethnic minority population considerations

  • Address personal and social factors. Health status may be improved if interventions address both personal and underlying social factors that influence health behaviors related to heart disease and stroke (Shaya, 2006).
  • Use familiar settings. In racial and ethnic minority communities, churches (Flack, 1990; Ofili, 1999), schools (Ofili, 1999), health care facilities (Ofili, 1999) and small work sites (Ofili, 1999; Williams, 2004) may be ideal settings for community-based interventions aimed at reducing heart disease and stroke risk factors.
  • Address language barriers. It is important to develop more effective health education strategies for non-English-speaking communities (DuBard, 2006).  Program materials should also be at an appropriate literacy level for the priority populations.
  • Involve the community of interest. 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 interventions. This may include increasing the number of minority health care providers in your priority populations.
  • Engage community stakeholders. Leadership and active participation by community members, especially health care providers and community and religious leaders, can strengthen the credibility of and respect for the intervention.  By engaging leaders and getting active participation by community members, you may be able to strengthen the credibility of and respect for the intervention.
  • 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 affect the population at hand (Pandey, 2005). 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 a population in general (USDHSS, 2000). This may mean taking into consideration characteristics such as the community’s primary language, common phrases and terms used by the community, visual imagery (e.g., photos, colors and symbols) that represents the community and their experiences when designing intervention components, materials and incentives.
  • Increase awareness and knowledge. Information regarding heart disease and stroke risk factors and symptoms should be accompanied with a clear message of why this information is important, particularly in ethnic groups with a relative distrust of the medical system (Hunt, 2003). 
  • Increase access to health care. Improving access to care may reduce racial and ethnic disparities in risk factor identification and management and heart disease and stroke outcomes. (Edelman 2008)

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