Academic journal article Research and Theory for Nursing Practice

Compliance with Antihypertensive Medication in Chinese Immigrants: Cultural Specific Issues and Theoretical Application

Academic journal article Research and Theory for Nursing Practice

Compliance with Antihypertensive Medication in Chinese Immigrants: Cultural Specific Issues and Theoretical Application

Article excerpt

This paper presents a theoretical framework to study medication compliance in Chinese immigrants with hypertension (HTN). The framework was developed from (a) literature review of medication compliance and Chinese cultural belief/practices and (b) critique of major models of health behaviors in persons with chronic illness. Four constructs shape the model: motivation, cultural health perceptions, modifying factors, and cultural health care activities. Among these constructs, cultural health perceptions and health care activities are especially important because these address how Chinese immigrants perceive HTN and antihypertensive treatments and how they manage HTN. Using a culturally sensitive model is important to guide studies of medication compliance in this population and to assist health care providers to support compliance with antihypertensive treatments for Chinese immigrants.

Keywords: hypertension; Chinese immigrants; medication compliance; cultural factors; sick role behavior model

Hypertension (HTN), defined as a systolic blood pressure =140 mmHg and/or diastolic blood pressure =90 mmHg (Joint National Committee, 1997, 2003), is a preventable risk factor for both stroke and heart disease (Joint National Committee, 1997, 2003). The consequences of uncontrolled HTN are strokes and heart attacks, which are major public health concerns. In the United States, HTN contributes to 17.1% of the overall death rate (American Heart Association, 2005).

Problems associated with uncontrolled HTN also have significant financial and social implications for the individual, family, and society (Joint National Committee, 1997, 2003). For example, in the United States, the average annual medical cost for controlled HTN is $124 per person, while the annual average cost for uncontrolled HTN is five times as high at $691 (Campbell, 1996). To enhance quality of life and prevent financial and social burden, treatments to better control blood pressure are of paramount concern. HTN management includes both lifestyle modification and medication ( Joint National Committee, 1997, 2003; Moser, 1990, 1998). For medication to be effective, compliance, defined as taking at least 80% of prescribed medications (Sackett, Haynes, & Tugwell, 1985), is important.

Medication compliance is a concern across all populations but especially among minority groups where health care disparities exist. Chinese immigrants are a large minority population in the United States (U.S. Bureau of the Census, 2000), yet little is known about their HTN management practices, especially related to medication compliance (Li, Stewart, Stotts, & Froelicher, 2005). In recognition of the disparity revealed in health studies and services in minority groups, the Institute of Medicine recommended that immediate actions be taken (e.g., more research) to lay the foundation to enhance health care in minority populations (Institute of Medicine, 2003). This article responds directly to this recommendation by focusing specifically on Chinese immigrants.

Chinese immigrants constitute the largest proportion (25%) of Asian Americans and Pacific Islanders (10.2 million in 2000) in the United States (U.S. Bureau of the Census, 2000). The most recent data show that age- and gender-adjusted prevalence rates of HTN among Chinese in the United States are 11.8% for men aged 18-49, 6.4% for women aged 18-49, 45.0% for men over 50, and 34.3% for women over 50 (Stavig, Igra, & Leonard, 1988). Of Chinese immigrants with HTN, only 42% know that they have HTN, compared to 56% in the overall U.S. population (Stavig et al., 1988). About half do not know the serious consequences of uncontrolled HTN and only 15% of Chinese immigrants know that HTN is not associated with any symptoms (compared to 31% in the overall population) (Stavig et al., 1988).

For Chinese immigrants who are taking antihypertensive medications, compliance is critically important for blood pressure control. …

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