gerd cultural considerations ppt
DESCRIPTION
TRANSCRIPT
A STUDY
Prevalence, Knowledge, and Care Patterns for GERD in U.S.
Minority Populations
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%
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
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
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.
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
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
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)
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.
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
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%
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%
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%
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%)
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
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
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
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
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
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
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
Table 1: Study Population Demographics
Table 2: Heartburn by Racial Group and Frequency
Table 3: Logistic Regression of Monthly GERD Symptoms
Table 4: Awareness and Knowledge of GERD by Racial Group
Table 5: Care Seeking Patterns for GERD by Racial Group
Table 5: Care Seeking for GERD by Racial Group (cont.)