How Ghanaian, African-Surinamese and Dutch patients perceive and manage antihypertensive drug treatment: a qualitative study

Abstract

General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. Abstract ObjectivesTo explore and compare how Ghanaian, African-Surinamese (Surinamese), and WhiteDutch patients perceive and manage antihypertensive drug treatment in Amsterdam, Netherlands. MethodsQualitative study was conducted using detailed interviews with a purposive sample of 46 hypertensive patients without comorbidity who were prescribed antihypertensives. ResultsPatients in all the ethnic groups actively decided how to manage their prescribed antihypertensive regimens. In all the groups, confidence in the doctor and beneficial effects of medication were reasons for taking prescribed antihypertensive dosage.Particularly, ethnic-minority patients reported lowering or leaving off the prescribed medication dosage. Explanations for altering prescribed dosage comprised disliking chemical medications, fear of side effects and preference for alternative treatment.Surinamese and Ghanaian men also worried about the negative effects of antihypertensives on their sexual performance. Some Ghanaians mentioned fear of addiction or lack of money as explanations for altering prescribed dosage. Surinamese and Ghanaians often discontinued medication when visiting their homeland. Some respondents from all ethnic groups preferred natural treatments although treatment type varied. ConclusionPatients' explanations for their decisions regarding the use of antihypertensives are often influenced by sociocultural issues and in ethnic-minority groups also by migration-related issues. Self-alteration of prescribed medication among Surinamese and Ghanaians may contribute to the low blood pressure (BP) control rate and high rate of malignant hypertension reported among these populations in the Netherlands. This study provides new information, which can help clinicians to understand how patients of diverse ethnic populations think about managing antihypertensive drug treatment and to address ethnic disparities in medication adherence and BP control.

A Cross-National Comparative Study of Blood Pressure and Hypertension Between English and Dutch South-Asian- and African-Origin Populations: The Role of National Context

“…Hypertension treatment guidelines, adherence to therapy, practice patterns, and access to adequate antihypertensive therapy vary widely between countries. 20,21,[32][33][34] The UK hypertension guideline, for example, has been shown to give more attention to ethnic minority groups than the Dutch hypertension guideline. 21 More recently, multidisciplinary ethnicity and CVD consensus group has issued a document that provides an overview of ethnicity and CVD in the United Kingdom, with management recommendations based on a roundtable discussion.…”

“…34 In addition, the Dutch South-Asians came from Suriname. The living conditions in Suriname in the past 150 years were better than for the equivalent nonmigrating populations living in India over the same period.…”

Hypertension control in a large multi-ethnic cohort in Amsterdam, The Netherlands: The HELIUS study

“…Given the favourable treatment levels in ethnic minority groups in our study, it is conceivable that other factors such as non-compliance with antihypertensive therapy possibly driven by poor understanding of the relevance of BP control due to low level of education and cultural perceptions [28][29][30][31] and ethnic differential response to BP-lowering agents [23][24][25] may play a major role. In a qualitative study in Amsterdam, African Surinamese and Ghanaian residents perceived psychosocial stress as an important contributor to their high levels of hypertension and felt that a return to their homeland could even cure hypertension, as they perceived their BP to be low when they are in their country of origin.…”

Inhibitors and enablers of physical activity in multiethnic hypertensive patients: qualitative study

“…29 The topic list was constructed for a larger study that had the aim to explore patients' perceptions on hypertension. 30,31 It built upon earlier studies on patient perceptions of illness, 32,33 and was adapted for this study. The topic list was edited in Dutch and translated from Dutch into Ghanaian English by a Ghanaian-English translator.…”