Development and evaluation of a culturally appropriate hypertension education (CAHE) training program for health care providers.

Jennita G Meinema,Joke A Haafkens,Debbie A D C Jaarsma,Nynke Van Dijk,Henk C P M Van Weert,Christophe Leroyer

doi:10.1371/journal.pone.0178468

Abstract

BackgroundIn Western countries, hypertension and hypertension-related complication are more common in ethnic minority groups of African descent than in indigenous populations. Addressing ethnic minority patients’ perceptions of hypertension and its treatment through the use of cultural appropriate hypertension education (CAHE) increases adherence to medication and lifestyle recommendations. Given these effects, it seems warranted to develop a training program on how to deliver this type of patient education for Primary Care Nurse Practitioners (PCNPs).ObjectiveDevelopment and evaluation of a training program for PCNPs aimed at providing culturally appropriate hypertension patient education.DesignProspective cohort study evaluating attitude and intended behavioral changes.ParticipantsBoth experienced PCNPs and PCNPs in training participated in this study.Main measuresThe effects of the CAHE-training were measured by 3 different questionnaires on 1) the satisfaction with the training program, 2) the attitude towards culturally appropriate care, and 3) the commitment to change.ResultsThe CAHE-training program consists of 10 different components divided over two 4-hour sessions and was taught to 87 participating PCNPs. The program utilizes constructivist-learning principles and educational evidence on adult learning. The content of the program is based on the knowledge obtained from our previous studies on culturally appropriate care. The mean satisfaction-score was 7.5 (1–10 scale), with the role-play exercise with patient-actors scoring highest (8.2). We observed non-significant but positive changes in attitude. PCNPs who reported on the implementation of their intended behavior change showed significant attitude changes after three months.ConclusionWe demonstrated that our evidence based training program for PCNPs resulted in a positive learning experience with adequate intended behavioral changes in practice. Unfortunately, response rates were too low to demonstrate persistent changes in attitude.

Highlights

Hypertension is a major risk factor for cardiovascular disease. [1] In Western countries, hypertension is more common among ethnic minority groups of African descent than among the indigenous population [2,3,4]
The cultural appropriate hypertension education (CAHE)-training program consists of 10 different components divided over two 4-hour sessions and was taught to 87 participating Primary Care Nurse Practitioners (PCNPs)
PCNPs who reported on the implementation of their intended behavior change showed significant attitude changes after three months

Summary

Introduction

Hypertension is a major risk factor for cardiovascular disease. [1] In Western countries, hypertension is more common among ethnic minority groups of African descent than among the indigenous population [2,3,4]. In North America and Europe several interventions were developed to address specific risk factors of hypertension and treatment adherence in ethnic minority groups [10, 11] These interventions relate explicitly to the cultural perspective of patients. Addressing ethnic minority patients’ perceptions of hypertension and its treatment through the use of cultural appropriate hypertension education (CAHE) increases adherence to medication and lifestyle recommendations. Given these effects, it seems warranted to develop a training program on how to deliver this type of patient education for Primary Care Nurse Practitioners (PCNPs)

Methods

Results

Conclusion