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Hypertension and difficulties with the control of blood pressure are more common in African Americans than the white population. The premature onset of the condition (elevated blood pressure) complicates the issue as other comorbidities such as diabetes mellitus or chronic kidney disease lead to an elevated risk of mortality among African Americans even with no regard to the blood pressure (Ortega, Sedki, & Nayer, 2015).
Other factors that complicate and contribute to the development of hypertension include prevalent obesity among African Americans (one in six African American women are extremely obese) and salt sensitivity that is often present in African Americans with hypertension (Ortega et al., 2015). Both ethnicity and genetics can be related to the development of hypertension. Another problem is the presence of resistant hypertension that is more common for African Americans than whites and can cause such complications as “albuminuria, depressed kidney function, obesity, target-organ injury, diabetes, and severe BP elevations” (Ortega et al., 2015, p. 142). The antihypertensive drug resistance leads to decreased levels of control over the condition, which increases the risk of comorbidities.
Summary of Advocacy Campaigns
Equitable Care Health Outcomes (ECHO) was an advocacy campaign that aimed to address the disparities in control of hypertension among African Americans. Specific emphasis was put on the education of participants, culturally appropriate storytelling, behavioral counseling, self-management of blood pressure, and its monitoring (Bartolome, Chen, Handler, Platt, & Gould, 2016). In this campaign, proactive health care teams were engaged to provide African Americans who participated in the study with education and counseling. An important tool, in this case, was culturally appropriate and responsive care that was provided by trained and motivated physicians.
The second campaign was aiming at spreading and supporting disease prevention strategies among African Americans with the help of community-based churches and the clergy who worked there. As communication is believed to be one of the major components of disease prevention, the authors of the study and the campaign decided that the church as one of the most trusted institutions among African Americans could be engaged in the education of disease prevention (Lumpkins, Greiner, Daley, Mabachi, & Neuhaus, 2013).
The study demonstrated how pastors in predominantly African American churches advocated for health management. The identified strategies included the way pastors communicated behavior strategies that could help address disease prevention, pastors’ view of health problems in the congregation, the use of authority to promote health strategies, the relation between spirituality, religion, and health, and pastors’ encouragement of health events and advocacy (Lumpkins et al., 2013). An important factor was also the church’s role in health advocacy, where the church acted as an agent for health care equity.
Attributes That Made Campaigns Effective
In the first campaign, the attributes that contributed to its effectiveness were the following: educational programs that targeted treatment intensification were led by physicians; care teams consisted of motivated professionals where individual responsibilities were defined and divided accordingly; the use of new care delivery design, which aim was to encourage patients to have and follow their treatment plan; the use of risk stratification of the target population; and included culturally tailored programs (Bartolome et al., 2016).
The effectiveness of the second campaign was in its emphasis on spirituality and the support coming from the clergy. Here, the authors of the campaign considered the authority that the church had and measured the role of pastors in health promotion (Lumpkins et al., 2013). The empowerment of individuals, the encouragement of them becoming proactive, the use of interpersonal and group communication, pastors’ authority, and spirituality resulted in individuals’ increased attention to their health. The campaign demonstrated how effectively the combination of spirituality, health advocacy, and church authority could be utilized to encourage African Americans to pay more attention to their health, manage chronic illnesses and prevent conditions (including hypertension).
Health Advocacy Campaign Plan
Hypertension, as a disease more prevalent in African Americans, presents a serious public issue because current policies do not focus on the population from a culturally appropriate approach. The education of the population is based on accepted approaches that do not consider cultural specifics. The proposed policy will target African Americans specifically, providing a new, evidence-based, and culturally appropriate policy that will help increase the management of hypertension in the African American population and add a spiritual approach to it. The proposed solution consists of multiple steps:
- Physician-led care teams with clear team roles and responsibilities that will help patients monitor hypertension and manage it.
- Cross-cultural awareness workshops to increase the effectiveness of medical personnel in the provision of care appropriate for the chosen population.
- Team-building activities to positively influence the engagement of team members (Bartolome et al., 2016).
- Blood-pressure follow-up programs for nursing professionals that stimulates BP to recheck.
- Hypertension patient education by RNs or other team members.
- Implementation of spiritual practices and patient-centered education.
- Assistance from pastors and the clergy in promoting health-related events.
- Events dedicated to health practices should be integrated into the life of communities (Lumpkins et al., 2013).
- Possible media coverage to attract supporters (Dorfman & Krasnow, 2014).
Hypertension is a serious issue that can lead to complications and even fatal outcomes in the African American population. Although the healthcare system in the United States has different programs that target vulnerable populations (such as Medicare and Medicaid), prevention techniques and advocacy campaigns that emphasize the importance of disease prevention and management can be highly beneficial for the African American population (Knickman & Kovner, 2015).
The objectives of the policy are the following:
- Increase patient education effectiveness in hospitals and other healthcare facilities with the help of physician-led teams.
- Provide care that is based on cross-cultural awareness.
- Create workshops dedicated to patients’ healthcare plans and integrate them into healthcare facilities.
- Add spiritual counseling as a complementary form of care in healthcare facilities.
- Increase the number of patients (throughout the state) who complete BP recheck and visit follow-ups.
- Promote dietary and physical activity interventions among African American patients to decrease the risk of hypertension and subsequent complications.
- Support evidence-based approaches in teams that provide care to African Americans with hypertension.
- Increase the number of events dedicated to hypertension in African American communities (Leyk et al., 2014).
- Engage the church in African American communities as an advocate for correct self-management and screening for cardiovascular risks.
As can be seen, both structural and transformative changes are needed. Teams that provide care to African Americans with hypertension need to learn how cultural specifics can assist them in making management and treatment more effective. The church and the clergy can help in promoting healthcare-related events at local communities, as well as provide psychological and spiritual help to those African Americans who have the condition and need spiritual guidance.
Bartolome, R. E., Chen, A., Handler, J., Platt, S. T., & Gould, B. (2016). Population care management and team-based approach to reduce racial disparities among African Americans/Blacks with hypertension. The Permanente Journal, 20(1), 53-59.
Dorfman, L., & Krasnow, I. D. (2014). Public health and media advocacy. Annual Review of Public Health, 35, 293-306.
Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Health care delivery in the United States (11th ed.). New York, NY: Springer Publishing.
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Leyk, D., Rohde, U., Hartmann, N. D., Preuß, P. A., Sievert, A., & Witzki, A. (2014). Results of a workplace health campaign: What can be achieved? Deutsches Ärzteblatt International, 111(18), 320-327.
Lumpkins, C. Y., Greiner, K. A., Daley, C., Mabachi, N. M., & Neuhaus, K. (2013). Promoting healthy behavior from the pulpit: Clergy share their perspectives on effective health communication in the African American church. Journal of Religion and Health, 52(4), 1093-1107.
Ortega, L. M., Sedki, E., & Nayer, A. (2015). Hypertension in the African American population: A succinct look at its epidemiology, pathogenesis, and therapy. Nefrología, 35(2), 139-145.