Nursing Article On Hypertension

Introduction

Studies have identified hypertension as health care problem that affects millions of people worldwide. This problem affects people from different races differently, but there is a general consensus among scholars that the risk of developing hypertension increases with age. Numerous qualitative and quantitative studies have been conducted to determine the disease causes, risk factors, and management. This critique would identify an article authored by Vuruell-Fuentes, Ponce and Alegria (2012) with specific focus on literature review, methods, data, analysis, research purpose, theoretical framework, and variables that the authors used to reach at their research conclusions.

Research Purpose/Problem

Vuruell-Fuentes, Ponce and Alegria (2012) sought to establish the link between individual-level factors and the risk of developing hypertension among Latino Americans living In Chicago, Illinois. Particularly, the authors wanted to determine whether Latinos were less likely to be screened for hypertension and have their condition controlled. More specifically, neighborhood-level factors are identified as major predictors of individuals’ health and health care. Latino Americans tend to bear disproportionate burden of hypertension compared to non-Hispanic whites. They are also associated with a higher burden of disability and injury for specific healthcare outcomes. Other racial groups experience certain health advantages though not generalized across all healthcare outcomes. In the case of hypertension, according to Vuruell-Fuentes, Ponce and Alegria (2012) healthcare outcomes disadvantages are eroding slowly among Latinos. Latinos are less likely to seek help for their healthcare conditions and to have their hypertensive conditions managed or controlled. At individual levels, Latinos have lower levels of health insurance coverage in addition to having lesser access to healthcare, which have been underlying factors for these disparities. Furthermore, there are socio-demographic and economic of the environments in which Latinos live and lack of health-promoting resources also contribute to health disparities. Thus, the study by Vuruell-Fuentes, Ponce and Alegria (2012) to examine the connection between Latin Americans and immigrants’ environment composition in Chicago Illinois, and how these compositions contribute to several healthcare outcomes. These outcomes range from the risk of developing hypertension, the probability of using hypertension-related health care, and likelihood of being treated for hypertension. The authors also identify the need to investigate whether neighborhood-related factors vary by native status and language. Ideally, this is an important study given that America is seeking for ways to reduce healthcare disparities and ensure equal and increased access to health among all its citizens regardless of economic, social, or racial backgrounds.

Review of the Literature

The study by Vuruell-Fuentes, Ponce and Alegria (2012) is informed by a comprehensive review of the literature. The main focus of the literature review is on characteristics of neighborhoods in which Latinos live. These characteristics include “availability and accessibility of healthcare services, attitudes towards health and health-related behaviors, stress levels and availability of social support, and infrastructure deprivation (absence of stores selling health foods at affordable prices and lack of parks” (Vuruell-Fuentes, Ponce and Alegria, 2012). These characteristics are considered important predictors of quality of health in this article. The other thematic focus of the literature review is on neighborhood factors and their effects on the ability of healthcare professionals to intervene and to levels of structural inequalities.

The article’s literature review found that neighborhoods that have high concentrations of Latinos and other immigrant groups have both negative and positive health care outcomes. For this reason, access to Latino-specific resources and improved Latino-immigrant institutions and resources may help this vulnerable group to navigate healthcare systems. High concentration of Latinos is also associated with consumption of high-fat diets and lower levels of obesity (Livingston, Minushkin, Cohn, 2009). Latinos have better access to healthy foods and rank high in health-seeking behaviors. However, these beneficial aspects of Latinos tend to be evident only selectively to certain healthcare outcomes and certain subgroups. Deleterious effects of Latino concentration have also been recorded, including low vegetable and fruits intake, lack of physical activity, low neighborhood safety and walkability, and low access to recreational facilities. Some sub-groups, such as U.S.-born Latinos, reflect blacked social and economic opportunities.

The other aspect of Latinos that affect their healthcare access and outcomes is the access to health insurance. According to Brown et al. (2004), Insured Latinos, compared to insured Whites, experience disparities in access to healthcare. Among Americans who experience poor health, “Latinos are less likely to visit doctors or clinics compared to Whites” (Doshi, Ying-Lai, Azen, Varma & Los Angeles Latino Eye Study Group, 2008). This is an observation that suggests that even for the insured Latinos, neighborhood characteristics, which include nativity and English language proficiency, have effects on health. Vuruell-Fuentes, Ponce and Alegria (2012) amplify the need to investigate the extent to which these characteristics impact on Latinos’ hypertension-related healthcare outcomes. In of the few studies that investigate the link between neighborhood characteristics and hypertension-related healthcare outcomes, it was found that neighborhood contexts are responsible for a substantial proportion of racial disparities in hypertension awareness and prevalence (Livingston, Minushkin, Cohn, 2009). However, this study did not explain the extent to which neighborhood-related contexts account to disparities in treatment and control.

Theoretical Framework

The article by Vuruell-Fuentes, Ponce and Alegria (2012) is based on a theoretical framework. This framework is based on the theory that neighborhood and individual-related factors have far-reaching impact as far has prevalence of hypertension is concerned. In theory, it has been argued that high level of immigrants is a factor that contributes both positively and negatively to health care outcomes (Borrell, 2006). This is an important theoretical framework for this study because it helps this study to create a deeper understanding of the relationship between concentration of immigrant Latino’s and the risk of developing hypertension and other related diseases or conditions. The framework, for example, had helped the researchers to unearth the relationship that exist between neighborhood concentration of Latinos and several hypertension-related outcomes. Secondly, since healthcare disparities have shown to more among Spanish speakers, the framework has been used as the basis for whether or not the concentration of Spanish speakers differs according to nativity status and language. Following Andersen’s Model, the researchers considered predisposition factors, need factors, and enabling factors and included nativity and language types as predictors of access to healthcare and differences in healthcare outcomes.

Variables/Hypotheses/Questions/Assumptions

The independent variables that are being investigated in this article are neighborhood-related and individual level variables. Neighborhood-related variables included indicators of socio-economic status, family structures, age composition, racial composition, and residential stability. Individual-level variables, on the other hand, included health behaviors, sex, age, and marital status. All variables are weighed to account for neighborhood clustering and household size. Though the research question is not stated explicitly, the question that the research intents to answer is whether or not individual and neighborhood factors affect prevalence and access to hypertension health care among Latinos. It was hypothesized that these factors affect hypertension outcomes among Latinos.

Methodology

The article by Vuruell-Fuentes, Ponce and Alegria (2012) uses quantitative methodology. In this case, the authors analyzed cross-section survey data from (CCAHS) Chicago Community Adult Health Study. According to McCusker and Gunaydin (2015), quantitative studies place emphasis on measurements and statistics, and thus, suitable for studies in which numerical analysis is required. A sample of 3,105 adults living in Chicago was used and stratified into 343 neighborhoods. Face-to-face interviews were also used to collect responses from households. The choice of CCAHS was well informed because unlike census data, CCAHS data contains meaningful information about social and physical boundaries (Bersamin, Stafford & Winkleby, 2009). The study’s reliability, however, was compromised by the fact that researchers based their study on unmeasured characteristics. Ethical considerations were met because researchers sought institutional approval from University of Illinois’ institutional review board.

Data Analysis

The data analytic strategy for this study involved a presentation of weighted descriptive statistics for each variable. This was then followed by logistic regression to investigate the link between neighborhood characteristics and individual level characteristics. Additionally, the researchers included terms in order to account for interactions between Latino’s neighborhood concentration and language and nativity status. The variables were also weighted to account for household size, selection rates, and neighborhood clustering. These analyses used a complex survey tool that is known as Stata, version 10.

Summary/Conclusions, Implications, and Recommendations

From this study, it emerges that Latino’s neighborhood composition of neighborhoods are associated with marginalized utilization of healthcare for hypertension. This marginalization occurs in areas that range from doctor visits and healthcare insurance to taking of hypertension medication. The findings of this study, however, cannot be generalized to other metropolitans outside Chicago because of differences in demographic, economic, and social conditions. The limitation of study is that it used a small sample, which prevented the researchers from disintegrating the target groups into subgroups. The implication of this study to the field of nursing is that it can inform formulation of policies that seek to make Latino-concentrated neighborhoods more accessible in terms of distance, language, and cost.

References

Bersamin, A., Stafford, R. S., & Winkleby, M. A. (2009). Predictors of hypertension awareness, treatment, and control among Mexican American women and men. Journal of general internal medicine, 24(3), 521.

Borrell, L. N. (2006). Self-reported hypertension and race among Hispanics in the National Health Interview Survey. Ethnicity and Disease, 16(1), 71.

Brown E.R, Davidson P.L, Yu H, Wyn R, Anderson RM, Becerra L. (2004). Effects of community factors on access to ambulatory care for lower-income adults in large urban communities. Inq J Health Care ; 41(1):39–56

Doshi, V., Ying-Lai, M., Azen, S. P., Varma, R., & Los Angeles Latino Eye Study Group. (2008). Socio-demographic, family history, and lifestyle risk factors for open-angle glaucoma and ocular hypertension: the Los Angeles Latino Eye Study. Ophthalmology, 115(4), 639-647.

Livingston G, Minushkin S, Cohn D. (2009). Hispanics and health care in the United States: access, information and knowledge. Washington, DC: Pew Hispanic Center and Robert Wood Johnson Foundation Research Report

McCusker, K., & Gunaydin, S. (2015). Research using qualitative, quantitative or mixed methods and choice based on the research. Perfusion, 30(7), 537-542.

Viruell-Fuentes, E. A., Ponce, Ninez. A., & Alegría, M. (2012). Neighborhood context and hypertension outcomes among Latinos in Chicago. Journal of immigrant and minority health, 14(6), 959-967.