Diet and Exercise as Domains for Cultural Sensitivity: How Practices Vary Among Four Ethnic Groups with Chronic Illness

BACKGROUND: Physicians face significant challenges in understanding how their patients' cultural and ethnic background may affect their diet and physical activity levels. These differences are especially relevant in managing chronic diseases such as diabetes and hypertension. Medical personnel may be uncertain how to prescribe culturally appropriate and sensitive changes in order to increase rates of adherence. SIGNIFICANCE: Gaps remain in research conducted to date on how perceptions of and adherence to provider recommended diet and physical activity plans vary by ethnic and cultural background. In an NCI-funded project The Impact of Cultural Differences on Health Literacy and Chronic Disease Outcomes, we are exploring cultural factors associated with health outcomes, including patient's perceptions of and adherence to diet and exercise advice. Our study includes four ethnic groups (White, African-American, Vietnamese and Latino/Puerto Rican) served by one inner city community health center whose mission is to provide health care to low income and immigrant populations. METHODS: We conducted formative focus groups with 5-10 clinic patients from each of the four ethnic groups above to explore perceptions of diet and exercise. We are completing epidemiological surveys with 100 patients from each group who have been diagnosed with diabetes, hypertension or both. Surveys are orally administered in the language of the patient's choice. Data are analyzed using SPSS and Atlas.ti. FINDINGS: Variation in perceptions of diet and exercise and adherence to health care provider recommendations across ethnic/cultural groups will be discussed. Special attention will be given to cultural beliefs and practices regarding diet and exercise, barriers to adhering to diet and exercise plans, and the impact of poverty as identified through qualitative and quantitative data collection efforts. DISCUSSION AND CONCLUSIONS: Cultural differences among ethnic groups and between patients and providers play a significant role in shaping patient's adherence to diet and exercise regimens. This study integrates qualitative exploratory data with quantitative findings on patient adherence to develop recommendations for primary health care providers on chronic disease management for ethnically diverse patients with limited health literacy. Our recommendations for providers will facilitate culturally sensitive patient-provider communication and maximize patient adherence, specifically in the domains of diet and exercise.