Blood pressure control among Hispanics living in the US.-Mexico border: Implications for program implementation using community health workers

Background-This CDC-funded project was designed to establish community-based participatory approaches for developing education and community-outreach to control blood pressure among Hispanics/Mexican-Americans.

Method-Before intervention development, a community assessment investigated factors associated with awareness and perceived barriers to hypertension control in 150 subjects, (75 Ciudad Juarez, 75 El Paso, Texas). We examined self-reported blood pressure, use of anti-hypertensive medication, and actual blood pressure. We assessed Health Belief Model and Reasoned Action constructs to better understand attitudes about blood pressure control.

Results- In both cities, the majority were married, age 41 or older, with less than a high-school education. Almost all believed they were susceptible to hypertension complications, that complications were serious, and there were benefits to lifestyle changes. The most important barriers were fear that medications cause other problems (52%), lack of transportation (38%), cost of healthy foods (42%) and cost of medications (47%). Respondents also admitted not liking the taste of healthier foods (39%). Most reported high self-efficacy for taking medication, cooking without fat, and avoiding fast-food, but fewer were confident they could engage in regular physical activity, eat five fruits and vegetables a day, or avoid adding salt to foods. Most reported taking medications, taking them exactly as prescribed and believed their blood pressure was under control. A total of 68 El Paso respondents had a BP check. Based upon systolic BP, 22% were normotensive, 25% pre-hypertensive, 35% stage 1 and 18% stage 3. Of those reporting always taking their meds as prescribed, 19% were normotensive, 28% pre-hypertensive, 38% stage 1, and 15% stage 2.

Conclusions-- Respondents were generally had uncontrolled hypertension, but believed differently. There are several barriers to hypertension control. The intervention will address these barriers and should increase blood pressure control in this population.