Engaging Community in the Quality of Hypertension Care Project with Hmong Americans
Wong, Candice, Mouanoutoua, Vangleng, Chen, Meng-Jinn, Journal of Cultural Diversity
Abstract: This paper describes the collaborative endeavors between researchers and the Hmong community to develop and test a quality of hypertension care survey instrument. In-depth interviews with community leaders and hypertensive patients enhanced the understanding of quality of care from Hmong socio-cultural perspectives. Knowledge gained from the Hmong community was integrated into the research process. The collaborative process led to generating a culturally sensitive survey instrument, overcoming cultural barriers for recruitment of survey participants, and facilitating community involvement in all aspects of research implementation. Applying community-sensitive research methods ensured the success of the project.
Key Words: Asian Americans, Hmong Americans, Community-Sensitive Research, Cultural Competency, Hypertension
Asian Americans and Pacific Islanders (AAPI) are the fastest growing racial/ethnic groups in the United States (National Center for Health Statistics, 2000). Immigration, rather than birthrate, is the primary cause for this population growth (U.S. Immigration and Naturalization Service, 1998). These groups typically possess values and perceptions consistent with the traditional attitudes of their homelands rather than those of American society. Differences in languages, beliefs, and practices pose tremendous challenges for mainstream researchers and health care providers as they strive to improve the quality of health care in these communities (Office of Research on Minority Health, 1996; Chen, 1996; Hoang & Erickson, 1982; Jenkins, Le, McPhee et al., 1996; Muecke, 1983; Pham, Rosenthal, & Diamond, 1999). Thus, recognition of population diversity and disparities in health status among AAPIs has heightened awareness of the need for community-sensitive research that involves an active partnership with community members and for culturally-appropriate methods to conduct this research (Chen, Wismer, Lew et al., 1997; Hatch, Moss, Saran, et al., 1993; Levine, Becker, Bone et al., 1992; Novotny, & Healton eds., 1995; Hall, 1992; Israel, Schulz, Parker et al., 1998; Macaulay, Commanda, Freeman et al., 1999).
In particular, Hmong Americans, former refugees from the rural highlands of Laos, have been especially vulnerable to cultural, linguistic, and economic separation from modern medical systems. The 1990 U.S. Census indicated that among all AAPIs, Hmong had the highest poverty rate (63% in 1989) and the highest proportion of those who were linguistically isolated (61%) (U.S. Census Bureau, 1998). California's Central Valley is home to the second largest concentration of Hmong in the country (Ellis, 2002). In 1994, after nearly two decades of Hmong resettlement in the United States, conflicts arose between the Hmong community and medical institutions in Fresno (Traugott & Alpers, 1997; Pulaski, 1994, Oct. 11; Pulaski, 1994, October 14; Fontana, 1994, Novemberl). These conflicts involved medical diagnoses and treatments that conflicted with Hmong traditional beliefs, and the perception that health care providers used coercion as a method to treat patients without taking patient preferences into account.
One well-publicized case exemplifies the nature of these conflicts (Traugott & Alpers, 1997; Pulaski, 1994, October 11; Pulaski, 1994, October 14; Fontana, 1994, November 1). A 15-year old Hmong girl, initially thought to have acute appendicitis, had one of her ovaries removed during surgery when ovarian cancer was discovered. Although the patient's parents initially gave consent for an appendectomy, they were not informed of and did not consent to the removal of the ovary. The parents' objection to the surgical removal of the ovary was related to the Hmong belief that one ovary is for the production of sons, the other for daughters, and a complete family consists of both, and concern for their daughter's ability to marry due to the loss of her full reproductive potential. …