title: How Ghanaian, African-Surinamese and Dutch patients perceive and manage antihypertensive drug treatment: a qualitative study.
abstract: OBJECTIVE
  To explore and compare how Ghanaian, African-Surinamese (Surinamese), and White-Dutch patients perceive and manage antihypertensive drug treatment in Amsterdam, the Netherlands.
  
  
  METHODS
  Qualitative study was conducted using detailed interviews with a purposive sample of 46 hypertensive patients without comorbidity who were prescribed antihypertensives.
  
  
  RESULTS
  Patients in all the ethnic groups actively decided how to manage their prescribed antihypertensive regimens. In all the groups, confidence in the doctor and beneficial effects of medication were reasons for taking prescribed antihypertensive dosage. Particularly, ethnic-minority patients reported lowering or leaving off the prescribed medication dosage. Explanations for altering prescribed dosage comprised disliking chemical medications, fear of side effects and preference for alternative treatment. Surinamese and Ghanaian men also worried about the negative effects of antihypertensives on their sexual performance. Some Ghanaians mentioned fear of addiction or lack of money as explanations for altering prescribed dosage. Surinamese and Ghanaians often discontinued medication when visiting their homeland. Some respondents from all ethnic groups preferred natural treatments although treatment type varied.
  
  
  CONCLUSIONS
  Patients' explanations for their decisions regarding the use of antihypertensives are often influenced by sociocultural issues and in ethnic-minority groups also by migration-related issues. Self-alteration of prescribed medication among Surinamese and Ghanaians may contribute to the low blood pressure (BP) control rate and high rate of malignant hypertension reported among these populations in the Netherlands. This study provides new information, which can help clinicians to understand how patients of diverse ethnic populations think about managing antihypertensive drug treatment and to address ethnic disparities in medication adherence and BP control.
authors.affiliation: Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. e.j.beune@amc.uva.nl
authors.forename: Erik J A J
authors.initials: EJ
authors.lastname: Beune
authors.forename: Joke A
authors.initials: JA
authors.lastname: Haafkens
authors.forename: Charles
authors.initials: C
authors.lastname: Agyemang
authors.forename: John S
authors.initials: JS
authors.lastname: Schuster
authors.forename: Dick L
authors.initials: DL
authors.lastname: Willems
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D044383:Black People / Q000523:psychology* / Q000706:statistics & numerical data; D000529:Complementary Therapies; D011307:Drug Prescriptions; D005260:Female; D005869:Ghana / Q000208:ethnology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000208:ethnology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D036301:Qualitative Research; D012646:Self Administration / Q000379:methods; D013532:Suriname / Q000208:ethnology; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data
chemical_list: D000959:Antihypertensive Agents