Academic journal article Journal of Nursing Measurement

Cultural Factors and Medication Compliance in Chinese Immigrants Who Are Taking Antihypertensive Medications: Instrument Development

Academic journal article Journal of Nursing Measurement

Cultural Factors and Medication Compliance in Chinese Immigrants Who Are Taking Antihypertensive Medications: Instrument Development

Article excerpt

Chinese immigrants in the United States have a moderate to high prevalence of hypertension, but little is known about antihypertensive medication compliance in Chinese immigrants. This study presents some first-generation measures of antihypertensive medication compliance in a sample of Chinese immigrants. A literature review and two qualitative pilot studies were conducted to generate culturally sensitive instruments. Items were developed to assess cultural factors and medication compliance in Chinese immigrants receiving antihypertensive medications. Cultural factors included measures of cultural health perception of hypertension, health perceptions of Chinese herbs, health perceptions of Western medications, beneficial self-care behaviors, and social support. Four medication compliance scales were developed. The applicability of these scales was tested in a Chinese immigrant population (n = 200). Cronbach's alpha for the cultural factors scales ranged from .57 to .91. Two of the medication compliance scales had Cronbach's alphas above .60. Results showed that most of the scales are applicable and acceptable in a Chinese immigrant population and had good reliability. However, further testing with a larger sample in other regions of the country is indicated.

Keywords: antihypertensive medications; Chinese immigrants; compliance; culture: hypertension; medication compliance

Hypertension is an important risk factor for many serious diseases, including stroke and heart diseas (Joint National Committee, 2003). The most recent data show a moderate to high prevalence of hypertension among Chinese immigrants in the United States: 45.0% for men age ≥ 50, 34.3% for women age ≥ 50, 11.8% for men age 18-49, and 6.4% for women age 18-49 (Stavig, Igra, & Leonard, 1988). Therefore, management of hypertension is important to prevent adverse consequences (e.g., stroke) in Chinese immigrants.

Compliance with antihypertensive medication is critical to ensure the effectiveness of interventions in long-term hypertension control. Medication compliance is defined as taking at least 80% of prescribed medications (Sackett & Haynes, 1976). Low medication compliance (36%-79%) remains a major concern in the control of hypertension in the general U.S. population (Cummings, Becker, Kirscht, & Levin, 1982; Daniels, Renee, & Daniels, 1994; Khalil & Elzubier, 1997; Kirscht & Rosenstock, 1977; Lim et al, 1992; Nelson, Stason, Neutra, & Solomon, 1980; Shea, Misra, Ehrlich, Field, & Francis, 1992; Shulman et al., 1982). However, little is known about medication compliance in the Chinese immigrant population (Hong & Bayat, 1999; Lipson & Meleis, 1999; Stavig et al., 1988; U.S. Department of Health and Human Services, 2000).

Chinese immigrants have their own Chinese medicinal practices, which have been rooted in Chinese culture for over 5,000 years (Ogden, 2001), and that profoundly influence their health perceptions and practices. Literature on non-Chinese immigrant populations shows that older age, higher education, perceived severity of hypertension (e.g., headache and dizziness), and benefits of Western antihypertensive medications are associated with medication compliance (Given, Given, & Simoni, 1978; Kyngas & Lahdenpera, 1999; Nelson et al., 1980; Sharkness & Snow, 1992). However, these results might not be applicable to Chinese immigrants due to their own health practices (e.g., Chinese medicine). Therefore, describing medication compliance and exploring factors associated with medication compliance specific to Chinese immigrants is an important research priority. When studying these (medication compliance and associated factors) in Chinese immigrants, having a culturally sensitive framework and instruments is an essential step. This is especially important in California because of its large Chinese population (980,000, about 3% of the California population and approximately 40% of all Chinese immigrants in the US) (U. …

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