Characterizing Cultural and Contextual Influences on Hypertension Management Health Behaviors Among Hispanic American Women

Abstract

Background

Hispanic American women experience uncontrolled hypertension at disparately high rates that, in turn, increases cardiovascular disease risk, the leading cause of death in this population. As a result, there is a need for culturally and contextually relevant blood pressure management interventions that promote healthy diets, physical activity, and stress reduction, which can be developed using community-informed approaches.

Objective

To characterize cultural and contextual influences on health behaviors used to manage blood pressure (diet, physical activity, stress management) among Hispanic American women with hypertension.

Study Design, Settings, Participants

Hispanic women with hypertension were recruited through a community clinic in Texas. Participants completed demographic surveys and an in-depth, semi-structured interview via phone. The interview guide was informed by the Nutritional Education DESIGN Procedure, an established nutrition education development framework.

Measurable Outcome/Analysis

Four researchers analyzed transcripts using a team-based directed content analysis approach in which each transcript was coded independently by two researchers using ATLAS.ti. Researchers built consensus around coding and themes through team discussions. Demographic data was analyzed using descriptive statistics.

Results

Participants (n=11) were 52±11.4 years old; most were Spanish speakers (73%) and of Mexican descent (73%). The following themes were constructed from the data: (1) participants expressed strong attachment to cultural foods they viewed as unhealthy and were resistant to adopting unfamiliar foods aligned with hypertension management diets; (2) many participants indicated concealing feelings of stress to prioritize family needs ahead of their own, though some reported finding stress-relief through physical activity; and (3) support from family and friends played a consistent and key role in adopting health behaviors.

Conclusions

Common elements of Hispanic culture, such as strong food identity, collectivism, familismo (i.e., a cultural value emphasizing family connection and loyalty), influenced health behaviors related to hypertension management. Incorporating strategies such as culturally relevant foods and recipes, as well as group support for physical activity and stress management, into hypertension management programs may strengthen intervention engagement and effectiveness for Hispanic American women.

Funding

USDA – National Institute of Food and Agriculture