Restricted accessResearch articleFirst published online 2008-3
“I didn’t tell them. Well,they never ask”. Lay understandings of hypertension and their impact on chronic disease management: implications for nursing practice in primary care
In the United Kingdom, as in other developed nations, there has been an increased research focus on ethnicity and the mediation of ethnicity on health and illness experience. This paper examines how lay understandings may affect chronic disease management and the steps primary care nurses may take to optimize care delivery for patients/families, using the example of hypertension in the African-Caribbean community. A focused ethnographic approach was adopted for this study. Data were first collected using focus group interviews (2), semi-structured interviews (21), and vignette interviews (5). Data were analyzed with the assistance of Atlas/ti qualitative analysis software using the principles developed by Roper and Shapira. Findings are presented using Kleinman’s seminal work as a theoretical framework: a) the aetiology or cause of the condition, b) the timing and mode of onset, c) the patho-physiological processes involved, d) the natural history and severity of the illness, e) the appropriate treatment for the condition. The paper concludes that it is incumbent upon primary health care nurses to recognize and take account of the lay explanations of health illness that patients/families hold. Failure to do so may compromise effective care-giving.
Atkin KAhmad WIUJones L . (2002) Young South Asian deaf people and their families: negotiating relationships and identities . Sociol Health Illn24: 21 – 45 .
5.
Berthoud R . (2001) Teenage births to ethnic minority women. Population Trends Summer 2001: 104: 12 – 17 .
6.
A BrahAE Coombes . (eds) (2000) Hybridity and Its Discontents Politics, Science and Culture, London : Routledge .
7.
Brogan CPickard DGray AFairman SHill A . (1998) The use of our of hours health services: a cross sectional survey . BMJ316: 524 – 527 .
8.
Brown Morris J . (2006) Hypertension and ethnic group . BMJ332: 833 – 836 .
9.
Bruni N . (1988) A critical analysis of transcultural theory . Aust J Adv Nurs5: 26 – 32 .
10.
Camphina-Bacote J . (2002) The process of cultural competence in the delivery of healthcare services: a model . J Transcult Nurs13: 181 – 184 .
11.
Cappuccio FP . (2001) Ethnicity and cardiovascular risk: variations in people of African ancestry and South Asian origin . J Hum Hypertens11: 571 – 576 .
12.
Cooney C . (1994) A comparative analysis of transcultural nursing and cultural safety . Nurs Prax N Z9: 6 – 12 .
13.
Culley L . (1996) A critique of multiculturalism in health care: the challenge for nurse education . J Adv Nurs23: 564 – 570 .
14.
L CulleyS Dyson . (eds) (2001) Ethnicity and Nursing Practice.Basingstoke : Palgrave .
15.
Department of Health (2002) Securing our Future Health: Taking A Long-term View – The Wanless Report.London : The Stationery Office .
16.
Department of Health (DOH) Farrell, C (2004a) Patient and Public Involvement in Health: The Evidence for Policy Implementation. London: The Stationery Office.
17.
Department of Health (2004b) The NHS Improvement Plan: Putting People at the Heart of Services.London : The Stationery Office .
18.
Department of Health (2006) Supporting People with Long Term Conditions to Self Care: A Guide to Developing Local Strategies and Good Practice.London : The Stationery Office .
19.
Dickerson JEBrown MJ . (1995) Influence of age on general practitioners’ definitions and treatment of hypertension . BMJ3: 574 .
20.
Fryer P . (1992) Staying Power: The History of Black People in Britain.London : Pluto Press .
21.
Gerrish KHusband CMcKenzie J . (1996) Nursing for a Multi-ethnic Society.Buckingham : Open University Press .
22.
Giger JNDavidhizar R . (2003) The Giger and Davidhizar transcultural assessment model . J Transcult Nurs13: 185 – 188 .
23.
Helman C . (2001) Culture, Health and Illness, fourth ed.Oxford : Butterworth-Heinemann .
24.
Higginbottom GMA . (2006) Pressure of life’: ethnicity as a mediating factor in mid-life and older peoples’ experience of high blood pressure . Sociol Health Illn28: 1 – 28 .
25.
Higginbottom GMAMathers N . (2006) The use of herbal remedies in self care and the promotion of general well-being by individuals of African Caribbean origin with hypertension. Divers. Health . Soc. Care3: 99 – 110 .
26.
Higginbottom GMAMathers NMarsh PKirkham MOwen JM . (2006) The experience of early parenthood amongst young people of minority ethnic origin in England: young parents, grandmothers and service providers’ views . Soc Sci Med63: 858 – 870 .
27.
Jenkins R . (1997) Rethinking Ethnicity.London : Sage Publications .
28.
Karlsen SNazroo JY . (2002a) Agency and structure: the impact of ethnic identity and racism on the health of ethnic minority people . Sociol Health Illn24: 1 – 20 .
29.
Karlsen SNazroo JY . (2002b) Relation between racial discrimination, social class and health among ethnic minority groups . Am J Public Health92: 624 – 631 .
30.
Kennedy Cruickshank JMbanya JCWilks RBalkau BForrrester TAnderson SG (2001) Hypertension if four African-origin populations: current ‘rule of Halves’ quality of blood pressure control and attributable risk of cardio-vascular disease . J Hypertens19: 41 – 46 .
31.
Kleinman A . (1988) The Illness Narratives: Suffering, Healing & the Human Condition.New York : Basic Books .
32.
Larbie JMare PBaxter C . (1987) Trainer's Handbook for Multiracial Health Care.London : National Extension College .
33.
Leininger M . (1991) Culture, Care Diversity and Universality: A Theory of Nursing.New York : National League for Nursing .
34.
Leininger M . (1995) Transcultural Nursing: Concepts, Theories, Research and Practice, .New York : McGraw-Hill Inc.
35.
Lloyd KJacob KPatel V . (1998) The development of the Short Explanatory Model Interview (SEMI) and it’s use among primary care attenders with common mental health disorders . Psychol Med28: 1231 – 1237 .
36.
Modood TBerthoud RLakey KNazroo JSmith PVirdee S (1997) Ethnic Minorities in Britain: Diversity and Disadvantage.London : Policy Studies Institute .
37.
Muecke MA . (1994) On the evaluation of ethnographies. In: JM Morse . (Ed.), Critical Issues in Qualitative Research Methods.Thousand Oaks, CA : Sage Publications , pp. 187–209.
38.
Nazroo JY . (1997) The Health of Britain's Ethnic Minorities, Policy Studies InstituteLondon .
39.
Nazroo JY . (2006) Health and Social Research in Multiethnic Societies.London : Routledge .
40.
Nazroo JYKarlsen S . (2003) Patterns of identity among ethnic minority people: Diversity and commonality. Ethnic and Racial Studies26: 902 – 930
41.
Papadopoulos I; Tilki I; Taylor G; . (1998) Transcultural Care: A Guide for Health Care Professionals. Dinton, Nr. Salisbury: Quay Books.
42.
Pound P , Gompertz, Ebrahim S (1998) Illness in the context of older age: the case of stroke . Sociol Health Illn20: 489 – 506 .
43.
Price KCortis J . (2000) The way forward in Transcultural Nursing . Nurse Edu. Today20: 233 – 243 .
44.
Purnell L . (2002) The Purnell Model for cultural competence . J Transcult Nurs13: 193 – 196 .
45.
Raleigh VS . (1997) Diabetes and hypertension in Britain’s ethnic minorities: implications for the future of renal services . BMJ314: 209 – 213 .
46.
Ramsden I . (1990a) Kawa Whakaruruhau: Cultural Safety in Nursing Education in Aotearoa.Wellington : Ministry of Education .
47.
Ramsden I . (1990b) Cultural Safety . N Z Nurs J83: 15 – 17 .
48.
Ramsden I . (1996) The Treaty of Waitangi and cultural safety: the role of the treaty in nursing and midwifery education in Aotearoa. In: Guidelines for Cultural Safety in Nursing and Midwifery Education.Wellington : New Zealand Council of Nurses , pp. 21–35.
49.
Ramsden I . (2000) Cultural Safety/Kawa whakaruruhau ten years on: a personal view . Nurs Prax N Z15: 4 – 12 .
50.
Ramsden I . (2001) Facing our political legacy. Kai Tiaki . Nurs N Z7: 1 .
51.
Rogers AEntwistle VPencheon D . (1998) A patient led NHS: managing demand at the interface between lay and primary care . BMJ316: 1816 – 1819 .
52.
Roper JMShapira J . (2000) Ethnography in Nursing Research.Thousand Oaks, CA : Sage Publications .
53.
Sanders CDonovan JDieppe P . (2002) The significance and consequences of having painful and disabled joints in older age: co-existing accounts of normal disrupted biographies . Sociol Health Illn24: 227 – 253 .
54.
Serrant-Green L . (2001) Transcultural nursing: a view from within . Nurse Educ Today21: 670 – 678 .
55.
Serrant-Green L . (2001) Black on black: methodological issues for black researchers working in minority communities . Nurse Res9: 30 – 44 .
56.
57.
Stevens GLeavey GLivingston G . (2004) Dementia and hypertension in African/Caribbean elders . Age Ageing33: 193 – 198 .
58.
Thorogood N . (1988) Health and the management of daily life amongst women of Caribbean origin living in Hackney. London: Goldsmith; College [unpublished thesis].
59.
Torkington NPK . (1995) Black migrant women and health . Womens Stud Int Forum18: 153 – 158 .
60.
Weinman JPetrie KMoss-Morris R . (1996) The illness perception questionnaire: a new method for assessing the cognitive representation of illness . Psychol Health11: 431 – 445 .
61.
Weiss M . (1997) Explanatory model interview catalogue (EMIC) . Transcult Psychiatry34: 235 – 263 .
62.
Whitehead MTownsend PDavidson NDavidsen N . (1992) Inequalities in health: the Black Report and the Health Divide, second ed.London : Penguin Social Sciences .
