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Figueroa JC, Paniagua-Avila A, Sub Cuc I, Cardona S, Ramirez-Zea M, Irazola V, Fort MP. Explanatory models of hypertension in Guatemala: recognizing the perspectives of patients, family members, health care providers and administrators, and national-level health system stakeholders. BMC Public Health 2022; 22:2320. [PMID: 36510216 PMCID: PMC9743515 DOI: 10.1186/s12889-022-14668-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Uncontrolled hypertension is a major public health burden and the most common preventable risk factor for cardiovascular diseases in Guatemala and other low- and middle-income countries. Prior to an initial trial that evaluated a hypertension intervention in rural Guatemala, we collected qualitative information on the needs and knowledge gaps of hypertension care within Guatemala's public healthcare system. This analysis applied Kleinman's Explanatory Models of Illness to capture how patients, family members, community-, district-, and provincial-level health care providers and administrators, and national-level health system stakeholders understand hypertension. METHODS: We conducted in-depth interviews with three types of participants: 1) national-level health system stakeholders (n = 17), 2) local health providers and administrators from district, and health post levels (25), and 3) patients and family members (19) in the departments of Sololá and Zacapa in Guatemala. All interviews were conducted in Spanish except for 6 Maya-Kaqchikel interviews. We also conducted focus group discussions with auxiliary nurses (3) and patients (3), one in Maya-Tz'utujil and the rest in Spanish. Through framework and matrix analysis, we compared understandings of hypertension by participant type using the Explanatory Model of Illness domains -etiology, symptoms, pathophysiology, course of illness, and treatment. RESULTS Health providers and administrators, and patients described hypertension as an illness that spurs from emotional states like sadness, anger, and worry; is inherited and related to advanced age; and produces symptoms that include a weakened body, nerves, pain, and headaches. Patients expressed concerns about hypertension treatment's long-term consequences, despite trying to comply with treatment. Patients stated that they combine biomedical treatment (when available) with natural remedies (teas and plants). Health providers and administrators and family members stated that once patients feel better, they often disengage from treatment. National-level health system stakeholders referred to lifestyle factors as important causes, considered patients to typically be non-compliant, and identified budget limitations as a key barrier to hypertension care. The three groups of participants identified structural barriers to limited hypertension care (e.g., limited access to healthy food and unaffordability of medications). CONCLUSION As understandings of hypertension vary between types of participants, it is important to describe their similarities and differences considering the role each has in the health system. Considering different perceptions of hypertension will enable better informed program planning and implementation efforts.
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Affiliation(s)
- Juan Carlos Figueroa
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Calzada Roosevelt 6-25 Zona 11, 01011, Guatemala City, Guatemala.
- Dornsife School of Public Health, Department of Epidemiology and Biostatistics, Drexel University, Urban Health Collaborative, Philadelphia, PA, USA.
| | - Alejandra Paniagua-Avila
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Calzada Roosevelt 6-25 Zona 11, 01011, Guatemala City, Guatemala
- Mailman School of Public Health, Department of Epidemiology, Columbia University, New York City, New York, USA
| | - Ingrid Sub Cuc
- Department of Native American Studies, University of California, Davis, Davis, CA, , USA
| | - Sayra Cardona
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Calzada Roosevelt 6-25 Zona 11, 01011, Guatemala City, Guatemala
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Calzada Roosevelt 6-25 Zona 11, 01011, Guatemala City, Guatemala
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Meredith P Fort
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Calzada Roosevelt 6-25 Zona 11, 01011, Guatemala City, Guatemala
- Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, USA
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Mitnick D, Dills A, Smith Slep AM, Heyman RE, Giresi J. Family Influences on Caries in Grenada. Dent J (Basel) 2020; 8:E105. [PMID: 32916915 PMCID: PMC7559639 DOI: 10.3390/dj8030105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022] Open
Abstract
If high-conflict family environments are cariogenic across cultures, and can be studied in cultures where both these environments and cariogenic dental practices are particularly prevalent, this would afford the opportunity to examine how these two pathways of risk might interact, laying the stage for culturally competent, integrated prevention efforts. The first investigation involved qualitative data about perceptions of oral health and family stressors in Grenadian families with school-aged children. The second study used a questionnaire and observational data to assess relations among oral health behaviors, relationship satisfaction, parenting, and child behavior; it also included a pilot study of Motivational Interviewing. Most of the themes discussed in focus groups suggested overlap between U.S. and Grenadian parents; possible culture-specific issues were high prevalence of single-parent homes, normativity of physical discipline, less preventive dental care, and more fatalistic view of oral health outcomes. Significant associations were found between parent and child oral health behaviors, between child externalizing and internalizing behaviors, and between family variables (e.g., relationship satisfaction, child behavior) and oral health behaviors (e.g., parent flossing, child brush time). The results strongly support the need for research on the relations between family functioning and oral health to be embedded within culture.
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Affiliation(s)
| | - Ashley Dills
- Department of Cariology and Comprehensive Care, New York University College of Dentistry, New York, NY 10010, USA; (D.M.); (A.M.S.S.); (R.E.H.); (J.G.)
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Bansilal S, Vedanthan R, Woodward M, Iyengar R, Hunn M, Lewis M, Francis L, Charney A, Graves C, Farkouh ME, Fuster V. Cardiovascular risk surveillance to develop a nationwide health promotion strategy: the grenada heart project. Glob Heart 2015; 7:87-94. [PMID: 25691303 DOI: 10.1016/j.gheart.2012.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 06/07/2012] [Accepted: 06/08/2012] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The Grenada Heart Project aims to study the clinical, biological, and psychosocial determinants of the cardiovascular health in Grenada in order to develop and implement a nationwide cardiovascular health promotion program. METHODS We recruited 2,827 adults randomly selected from the national electronic voter list. The main outcome measures were self-reported cardiovascular disease and behavioral risk factors, anthropometric measures, blood pressure, point-of-care testing for glucose and lipids, and ankle-brachial index. Risk factors were also compared with the U.S. National Health and Nutritional Survey data. RESULTS Prevalence of cardiovascular disease risk factors were: overweight and obesity-57.7% of the population, physical inactivity-23.4%, diabetes-13.3%, hypertension-29.7%, hypercholesterolemia-8.6%, and smoking-7%. Subjects who were physically active had a significantly lower 10-year Framingham risk score (p<0.001). Compared with the U.S. National Health and Nutrition Survey data, Grenadian women had higher rates of adiposity, diabetes, hypertension, and elevated low-density lipoprotein cholesterol, whereas Grenadian men had a higher rate of diabetes, a similar rate of hypertension, and lower rates of the other risk factors. Prevalence of peripheral arterial disease was 7.6%; stroke and coronary heart disease were equally prevalent at ∼2%. CONCLUSIONS This randomly selected adult sample in Grenada reveals prevalence rates of obesity, hypertension, and diabetes significantly exceeding those seen in the United States. The contrasting, paradoxically low levels of prevalent cardiovascular disease support the concept that Grenada is experiencing an obesity-related "risk transition." These data form the basis for the implementation of a pilot intervention program based on the Institute of Medicine recommendations and may serve as a model for other low- and middle-income countries.
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Affiliation(s)
| | | | - Mark Woodward
- George Institute, University of Sydney, Sydney, Australia
| | - Rupa Iyengar
- Mount Sinai School of Medicine, New York, NY, USA
| | - Marilyn Hunn
- Mount Sinai School of Medicine, New York, NY, USA
| | | | | | | | | | - Michael E Farkouh
- Mount Sinai School of Medicine, New York, NY, USA; University of Toronto, Toronto, Canada
| | - Valentin Fuster
- Mount Sinai School of Medicine, New York, NY, USA; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
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Oli N, Vaidya A, Subedi M, Krettek A. Experiences and perceptions about cause and prevention of cardiovascular disease among people with cardiometabolic conditions: findings of in-depth interviews from a peri-urban Nepalese community. Glob Health Action 2014; 7:24023. [PMID: 24802386 PMCID: PMC4007028 DOI: 10.3402/gha.v7.24023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 03/24/2014] [Accepted: 04/09/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Nepal currently faces an increasing burden of cardiovascular disease (CVD). Earlier studies on health literacy and the behavior dimension of cardiovascular health reported a substantial gap between knowledge and practice. OBJECTIVE This qualitative study aimed to deepen understanding of the community perspective on cardiovascular health from the patients' viewpoint. DESIGN We conducted in-depth interviews (IDIs) with 13 individuals with confirmed heart disease, hypertension, or diabetes mellitus. All participants provided verbal consent. We used an IDI guide to ask respondents about their perception and experiences with CVD, particularly regarding causation and preventability. We manually applied qualitative content analysis to evaluate the data and grouped similar content into categories and subcategories. RESULTS Respondents perceived dietary factors, particularly consumption of salty, fatty, and oily food, as the main determinants of CVD. Similarly, our respondents unanimously linked smoking, alcohol intake, and high blood pressure with cardiac ailments but reported mixed opinion regarding the causal role of body weight and physical inactivity. Although depressed and stressed at the time of diagnosis, respondents learned to handle their situation better over time. Despite good family support for health care, the financial burden of disease was a major issue. All respondents understood the importance of lifestyle modification and relied upon health professionals for information and motivation. Respondents remarked that community awareness of CVD was inadequate and that medical doctors or trained local people should help increase awareness. CONCLUSIONS This study provided insight into the perceptions of patients regarding CVD. Respondents embraced the importance of lifestyle modification only after receiving their diagnosis. Although better health care is important in terms of aiding patients to better understand and cope with their disease, interventions should be tailored to improve the community's cardiovascular health literacy and preventive practices.
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Affiliation(s)
- Natalia Oli
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden;
| | - Abhinav Vaidya
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal; Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | | | - Alexandra Krettek
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Nordic School of Public Health NHV, Gothenburg, Sweden
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Block RC, Dozier AM, Hazel-Fernandez L, Guido JJ, Pearson TA. An epidemiologic transition of cardiovascular disease risk in Carriacou and Petite Martinique, Grenada: the Grenada Heart Project, 2005-2007. Prev Chronic Dis 2012; 9:E90. [PMID: 22515972 PMCID: PMC3406739 DOI: 10.5888/pcd9.110167] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction The epidemiologic transition has made chronic disease a major health threat in the Caribbean and throughout the world. Our objective was to examine the pattern of lifestyle factors associated with cardiovascular disease (CVD) in Grenada and to determine whether the prevalence of CVD risk factors differs by subgroups. Methods We conducted a cross-sectional study of adult Grenadians between 2005 and 2007. We used a population-wide, community-based approach by adapting the World Health Organization's STEPwise Approach to the Surveillance of Chronic Disease survey for a local context. We collected behavioral, anthropometric, and blood sample data to assess the prevalence of CVD risk factors. Results An estimated 64% (n = 2,017) of 3,167 eligible adults participated in our study (60% women). With increasing age, consumption of fried foods declined, whereas fish intake increased. Adults aged 45 to 54 years had the highest obesity rate (39%). Large waist circumference was more common among women than among men. According to National Cholesterol Education Program criteria, 29% of participants had metabolic syndrome (47% ≥65 y; 36% women vs 17% men). Approximately one-fifth of participants had lived outside Grenada for more than 10 years. Participants who had migrated tended to be older and have different CVD risk factors than those who had never migrated. Conclusion In the midst of an epidemiologic transition in the Caribbean nation of Grenada in which CVD risk is increasing, dietary risk factors are most prevalent among women and among all adults younger than 55.
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Affiliation(s)
- Robert C Block
- Department of Community and Preventive Medicine, University of Rochester, Box 644, Rochester, NY 14642, USA.
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