Under Pressure II: evaluation of a culture sensitive educational programme for Afro Surinamese and Ghanaian patients with hypertension.

In Western countries, hypertension (HTN) is more prevalent among
ethnic-minority populations of African descent, and the HTN-related health
outcomes of these groups are worse than those of Europeans. In the Netherlands
high rates of HTN have been observed among two major immigrant groups of
African descent: African-Surinamese from the former Dutch colony of Suriname
(hereafter, Surinamese) and Ghanaians. Hypertension is a major risk factor for
cardiovascular morbidity and mortality. This risk can be prevented through
anti-hypertensive medication and lifestyle modification. However, compliance
with these measures is often low, particularly within ethnic minority
populations. Tailored forms of patient education and counselling can support
patients with the implementation of medication and lifestyle changes and
improve compliance. Based on in formation from a previous project (Heebroedoe)
the research group has developed a protocol for culturally sensitive patient
education (CSPE) for hypertensive patients for general practices. The protocol
was particularly focussed on patients from Ghanaian and Afro-Surinamese
descent. A follow up project demonstrated that the protocol is applicable in
practice, particularly by trained nurse practitioners (NP).

The overall aim of the study is to evaluate the effect of CVPE in
Afro-Surinamese and Ghanaian who are treated for HTN in general practice and
who have an uncontrolled blood pressure. (systolic BP > 140 mmHG and/or
diastolic BP > 90 mmHG)

The primary specific aim is;
To establish if patients who have received CVPE (intervention group) have a
significant reduction in their systolic BP (> = 10 mmHG) as compared to a
control group, at eight months after the start of the intervention.

Secondary specific aims are:
To evaluate if patients who have received CVPE (intervention group) show
significant differences in compliance with respect to medication use as
compared to a control group, at eight months after the start of the
intervention.
To evaluate if patients who have received CVPE (intervention group) show
significant differences in compliance with respect to life style
recommendations as compared to a control group, at eight months after the start
of the intervention.

Randomized controled trial, in which data will be collected at the level of the
patients and radomization will take place at the level of health care centers
(clusters). In addition to this a proces evaluation will be conducted to gain
insight in contextual factors that may influence the effect of the
intervention.

Patients in the intervention group will receive three educational counselling
sessions according to the protocol of culturally sensitive hypertension
education with an interval of three months. Patients in the control group will
receive care as usual.

1.
At baseline (T0) a research nurse will patients BP, weight length and
waistline) and a research assistent will conduct an interview with them.
2.
Patients in the control group will receive care as ususal. Patients in the
intervention group will receive three counselling consults with an interval of
three months from a nurse practitioner.

3. At three moments in patients of the intervention group and at two moments in
patients of the control group the BP will be measures and they will be asked to
fill out a short questionnaire regarding medication use and life style changes
(with an interval of three months).

4. At 8 months, base line measurements that were performed at (T0) will be
repeated: a research nurse will measure patients BP, weight length and
waistline and a research assistent will conduct an interview with them.

5. After 8 months, some patients (< =15) will be asked to provide a more
extensive interview regarding their experiences for the process analysis.