gerd cultural considerations ppt

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A STUDY Prevalence, Knowledge, and Care Patterns for GERD in U.S. Minority Populations

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Page 1: GERD Cultural considerations Ppt

A STUDY

Prevalence, Knowledge, and Care Patterns for GERD in U.S.

Minority Populations

Page 2: GERD Cultural considerations Ppt

A Quick Look

Study: Conducted to examine prevalence, awareness and care patterns for GERD across 4 ethnic groups (Caucasian, African-American, Asian, and Hispanic).

Method: Used a population-based, cross sectional, survey fielded in English, Chinese and Spanish

Results: 1,172 participants were included for analysis of GERD symptoms:

Monthly – 34.6% Weekly – 26.2% Daily – 8.2%

Page 3: GERD Cultural considerations Ppt

A Quick Look

As compared by ethnic groups: Hispanics – 50% Caucasians – 37% African-Americans – 31% Asians – 20%

Conclusion: The study confirms high prevalence rates in the Hispanic community, with Asian Americans experiencing higher rates in the U.S. than the Far East.

Also confirms a need for culturally appropriate education about GERD symptoms and treatment

Page 4: GERD Cultural considerations Ppt

Background Information

GERD defined as a chronic disorder characterized by heart burn and regulation.

Other studies show higher rates in Western Nations (20-40%) particularly in Caucasians.

Medical care was sought when symptoms impacted quality of life, self-treatment was ineffective, and when concern could be resolved with care and a prescription medication.

Cultural and Ethnic factors that affected seeking help: issues of trust, language, literacy and comprehension barriers

Page 5: GERD Cultural considerations Ppt

Background Information

Personal beliefs can also have an affect on seeking help. These include:

Beliefs about self-treatment Lack of control of health Modesty Embarrassment Fear of illness Attitude of fatalism

It was found that medical information was sought from the media and “word of mouth” more frequently than from healthcare providers.

Page 6: GERD Cultural considerations Ppt

This Study

This study was conducted to better understand prevalence, knowledge, and health seeking behaviors among ethnic groups.

A small, population-based, observational study (Philadelphia, PA) that looked at:

African Americans Asian Americans Hispanics Caucasians

Page 7: GERD Cultural considerations Ppt

Method

Study Population Included a minimum of 200 adults (≥18 years) Had to be from one of the four groups

African-American Asian Hispanic/Latino Caucasion

Targeted at least 200 from each group, attending local community centers or faith-based community activities.

Survey Methods: 36 question, 8 page survey adapted from Srinivasan’s

description survey and Locke’s validated instrument

Page 8: GERD Cultural considerations Ppt

Method

Domains include: Familiarity with term GERD Prevalence of heartburn Diagnosis of GERD Medication use Social impact Attitudes about seeking care Knowledge about heartburn or GERD Sources of information Beliefs about symptomatic relief for heartburn Beliefs about symptoms associated with heartburn Intentions for treating heartburn Demographics (gender, marital status, education, employment

status, income, race/ethnicity, weight, and height)

Page 9: GERD Cultural considerations Ppt

Method

Statistical Methods an Analysis: Data was entered into an Access database and analyzed

using SAS 9.1. The Prevalence of GERD was calculated for each of the

ethnic groups and then compared controlling for age, gender, and other demographic variables

Knowledge, attitudes and care seeking patterns were assessed for those reporting GERD symptoms and compared in the four ethnic groups

Questionnaire also featured two questions to assess: Prevalence of heartburn after a meal Prevalence after going to sleep

Final measure for prevalence to account for all who indicated experiencing heartburn in general, after a meal, and after going to sleep.

Page 10: GERD Cultural considerations Ppt

Results

1,172 surveys were included in the analysis African-Americans – 34% Caucasians – 27% Hispanics – 21% Asians – 18%

Population Prevalence: Observed differences in populations:

Monthly – 34.6% Weekly – 26.2% Daily - 8.2%

Statistically significant differences were found: 50% of Hispanics compared with 37.0% of Caucasians 30.8% of African-Americans compared with 19.9% of Asians

Page 11: GERD Cultural considerations Ppt

Results

Hispanics were shown to have highest rate of prevalence across all frequencies and Asians were shown to have the lowest across all frequencies.

Adjusted Monthly Prevalence: Age and gender differences in prevalence were found

between ethnic groups. These rates were:

Hispanics – 47.9% Caucasians – 36.1% African-Americans – 26.6% Asians – 20.4%

Page 12: GERD Cultural considerations Ppt

Results

Conditional Prevalence after Eating or Sleeping: Statistically significant differences found between the ethnic

groups for both conditions (after a meal and after going to sleep)

The “after a meal” rates were as follows and across all frequencies: Hispanics – 50.4% Caucasians – 40.7% African-Americans – 35.4% Asians – 27.5

The “after going to sleep” rates were as follows and across all frequencies:

Hispanics – 38.1% Caucasians – 29.6% African-Americans – 23.4% Asians – 19.5%

Page 13: GERD Cultural considerations Ppt

Results

General Occurrence of Heartburn The differences between the ethnic groups were

consistent with the differences in monthly prevalence The rates for heartburn in general were as follows:

Hispanics – 50.4% Caucasians – 36.3% African-Americans – 29.8% Asians – 20.4%

Page 14: GERD Cultural considerations Ppt

Results

Awareness and Knowledge of GERD: Study also assessed awareness and knowledge of GERD

symptoms Familiarity with terms

74.4% was familiar with the term “Gastro-esophageal Reflux Disease” or GERD

61.0% of males reported familiarity 80.2% of females reported familiarity Hispanics had the highest prevalence of GERD but

familiarity was lower (72.4%) compared to Caucasians (78.2%) and Asians (74.4%)

Page 15: GERD Cultural considerations Ppt

Results

Awareness and Knowledge of GERD cont.: Beliefs concerning continual occurrences of GERD:

76.3% who suffered symptoms believed serious heartburn could lead to ulcers, while 5.6% disagreed

Hispanics were more likely to disagree while Asians were least likely 44.9% who suffered symptoms believed serious heartburn could lead

to cancer, while 19.7% disagreed and 35.4% were neutral Participants across all ethnic groups were more confident that

heartburn could lead to ulcers and less confident that it could lead to cancer

Beliefs concerning treatment techniques for GERD: 19.1% of African-Americans and 21.8% of Hispanics believed that

lying down for 2-3 hours after eating would help control heartburn compared to 14.7% by Asians and 9.5% by Caucasians

46.2% of African-American and 45.5% of Hispanics believed that smaller more frequent meals might control heartburn compared to 72.1% by Asians and 57.8% by Caucasians

Page 16: GERD Cultural considerations Ppt

Results

Awareness and Knowledge of GERD cont.: Beliefs concerning treatment techniques for GERD:

19.1% of African-Americans and 21.8% of Hispanics believed that lying down for 2-3 hours after eating would help control heartburn compared to 14.7% by Asians and 9.5% by Caucasians

46.2% of African-American and 45.5% of Hispanics believed that smaller more frequent meals might control heartburn compared to 72.1% by Asians and 57.8% by Caucasians

Care Seeking Patterns: 33.7% of those that suffered GERD symptoms had been

diagnosed by a doctor No significant differences in diagnosis rates by a doctor

between gender, education level, or household income

Page 17: GERD Cultural considerations Ppt

Results

Care Seeking Patterns: 33.7% of those that suffered GERD symptoms had

been diagnosed by a doctor No significant differences in diagnosis rates by a

doctor between gender, education level, or household income

Page 18: GERD Cultural considerations Ppt

Results

In the case of experiencing severe heartburn symptoms: Hispanics were more likely to go to the clinic (28.9%) compared

to African-Americans (24.3%), Asians (20.6%), and Caucasians (12.2%)

African-Americans (37.6%) and Hispanics (28.9%) were more likely to go to the ER when suffering severe heartburn compared to Asians (19.1%) and Caucasians (16.3%)

41.8% of Asians and 35.7% of Hispanics indicated that cost and lack of health insurance would prevent then from seeing a doctor

Hispanics were more likely than other ethnic groups to not seek care from a doctor due to not being able to take time away form work or family

33.8% of Hispanics avoid seeking care from a doctor due to “fear or anxiety about going to the doctor” which is significantly higher than the other groups

Page 19: GERD Cultural considerations Ppt

Limitations of Study

Limitations of this study specific to definition, selection and exploration of physiological, psychological and social reasons for differences among ethnicities are as follows:

Designed to obtain unsolicited feedback at a community level from the four designated ethnic groups

Certain neighborhoods were selected possibly resulting in selection bias Study was conducted at community and faith-based facilities and health

fairs possibly resulting in selection bias There was no “randomization” in selection of participants Study instrument was adapted for Chinese and Spanish speakers and a

translator was available Translators may have unknowingly “lead” the participant to answer a

certain way Ethnicity was also self-selected by participants The study design did not accommodate for considering physiological,

psychological and social reasons for differences among ethnicities

Page 20: GERD Cultural considerations Ppt

Summary

The results show all four ethnic groups experience heartburn

GERD symptoms are more frequent in Hispanic Americans and lower in Asians living in the U.S. compared to other ethnic groups

Prevalence rates of African-Americans and Caucasians were similar to findings in other studies

Results reflect a need for education about GERD for all populations

The need is most pressing in the Hispanic population

Page 21: GERD Cultural considerations Ppt

Resource

Yuen, Elaine; Romney, Martha; Toner, Richard W.; Cobb, Nicole M.; Katz, Philip O.; Spodik, Maya;and Goldfarb, Neil I., "Prevalence, knowledge and care patterns for gastro-oesophageal reflux disease in United States minority populations." (2010). School of Population Health Faculty Papers. Paper 42.

http://jdc.jefferson.edu/healthpolicyfaculty/42

Tables that follow are also from this study and show the data obtained in a table format

Page 22: GERD Cultural considerations Ppt

Table 1: Study Population Demographics

Page 23: GERD Cultural considerations Ppt

Table 2: Heartburn by Racial Group and Frequency

Page 24: GERD Cultural considerations Ppt

Table 3: Logistic Regression of Monthly GERD Symptoms

Page 25: GERD Cultural considerations Ppt

Table 4: Awareness and Knowledge of GERD by Racial Group

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Table 5: Care Seeking Patterns for GERD by Racial Group

Page 27: GERD Cultural considerations Ppt

Table 5: Care Seeking for GERD by Racial Group (cont.)