(DASH) Diet Among Hispanics Along the US

Controlling Hypertension with the Dietary Approaches to Stop Hypertension (DASH)
Diet Among Hispanics Along the U.S.-Mexico Border
MONICA LAU, BSN, RN, DNP STUDENT | ADVISOR RUTH DEBOARD, PhD, RN, FNP-C
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PURPOSE
METHODS
The purpose of this project is to analyze the impact of individualized, culturally relevant Dietary
Approaches to Stop Hypertension (DASH) diet education on changes in dietary behaviors,
knowledge about HTN, and self-efficacy to manage HTN among Hispanics along the U.S.-Mexico
border.
Participants: age ≥ 18, Hispanic, diagnosed HTN or pre-HTN, able to provide consent.
BACKGROUND & SIGNIFICANCE
•  Approximately 66.9 million individuals in the U.S. have hypertension (HTN) and 53.5% are
uncontrolled (CDC, 2012).
Setting: Federally Qualified Health Center, U.S-Mexico border, medically underserved county.
Intervention: At pre-intervention, post-intervention, 2 and 4 week follow ups, participants answered
a questionnaire consisting of three, separate modified tools: REAP-S, HELM, and Self-Efficacy to
Manage HTN Scale with higher scores indicating good dietary habits, higher level of knowledge, and
higher self-efficacy, respectively. The REAP-S and Self-Efficacy scales were modified to a four-point
Likert scale. Results from the REAP-S portion of the pre-intervention questionnaire were used to
guide the one-to-one education intervention. At the conclusion of the intervention, participants were
given the DASH Education Tool to take home with a blood pressure log and information on how to
measure and record BP. Materials were offered in English or Spanish per participant preference.
•  Mexican-Americans have the lowest rates of awareness, treatment, and control (CDC, 2013).
•  Hispanics along the U.S.-Mexico border with HTN have low rates of adherence to lifestyle
management to control BP indicating a need for further interventions to control HTN among
this population (Ayala et al., 2012).
•  The dietary approaches to stop hypertension (DASH) diet: decrease sodium, cholesterol,
fat, and sugar intake and increase vegetable, fruit and low-fat dairy product intake to help
manage HTN (Moore et al., 2001).
•  DASH Diet Benefits: decreased BP, improved blood sugar control, improved weight
management, decreased incidence of cerebrovascular disease, stroke, and heart failure
(Blumenthal et al., 2010; Azadbakht et al., 2010; Eilat-Adar et al., 2013; Salehi-Abargouei et
al., 2013).
•  Among older Hispanics, DASH accordance ranges from 53-63% signifying poor accordance
and the need for customization of DASH diet education specific to the Hispanic culture
(Staffileno et al., 2013).
•  Patient-specific, culturally appropriate education is an effective teaching method among adults
for improving self-care and knowledge (Friedman et al., 2011).
•  Rapid Eating Assessment for Participants-Shortened version (REAP-S) is a modified
version of the Rapid Eating Assessment for Participants (REAP) tool (test-retest reliability of
0.86) and is used to assess dietary intake in the primary care setting, including willingness to
change dietary habits (Segal-Isaacson et al., 2004). Answer choices were modified to a fourpoint Likert scale ranging from ‘usually/often’ to ‘never.’ Results of the REAP-S may be used to
guide discussion between the provider and patient regarding nutrition.
•  Hypertension Evaluation of Lifestyle and Management Knowledge (HELM) scale is used
to assess HTN knowledge and self-management, consisting of multiple choice or true/false
answers (Schapira et al., 2012).
•  Self-efficacy to manage hypertension scale was derived from a general chronic disease
self-efficacy scale (Cronbach’s alpha = 0.81) and is used to assess self-efficacy (an
individual’s perceived ability) to manage HTN (Warren-Findlow et al., 2012). Answer choices
were modified to a four-point Likert scale ranging from ‘not at all confident’ to ‘completely
confident.’
PreIntervention
(wt., ht., SBP, DBP)
REAP-S, HELM,
DASH Diet
Education
PostIntervention
HELM
2 & 4 Week
F/U
(wt., SBP, DBP)
REAP-S, HELM,
Self-Efficacy
Self-Efficacy
OUTCOMES
•  A total of 7 individuals participated in the intervention.
•  Demographics: age range 28-71 yrs. (median 51.6 yrs.); one male, six females; all participants
identified themselves as Mexican; four (57.1%) participants had a 0-6th grade education, two
(28.6%) had a 10-12th grade education, and one (14.3%) participant completed college; six
(85.7%) participants were previously diagnosed with HTN and six (85.7%) participants were
taking antihypertensive medications.
•  Median scores for weight, SBP, DBP, REAP-S, HELM, and self-efficacy improved over both the
two-week and four-week periods after the patient education intervention.
•  The trend for median BMI increased over the four-week period with two missing data points,
resulting in a change of +2.0 kg/m2. The trend for willingness to change increased at the twoweek f/u with one participant indicating “not at all willing,” then a return to baseline level at the
four-week f/u.
Change in Outcomes of Interest from Baseline
Post-Intervention
2 Week F/U
Weight (lbs.)
n=7
-
-14
-13
BMI (kg/m2 )
-
+1.3
+2.0
SBP (mmHg)
-
-20.0
-22.0
DBP (mmHg)
-
-8.0
-8.0
REAP-S
-
+6.0
+5.5
Willingness to Change
HELM
Self-efficacy
4 Week F/U
-
+0.5
0.0
+1.0
+1.0
+1.0
-
-0.5
+2.5
With thanks & appreciation to Susana Jaruczyk, Karina Estrada, BSN, & Samantha Sanchez, BSN, RN
•
discover
•
deliver
Normal BP
Pre-HTN
HTN
SBP < 120 mmHg and
DBP < 80 mmHg
SBP 120-139 mmHg or
DBP 80-89 mmHg
SBP ≥ 140 or
DBP ≥ 90 mmHg
(JNC, 2003 & 2014).
CONCLUSIONS
•  Individuals of Hispanic or Latino origin at risk for or diagnosed with HTN should receive
culturally relevant DASH diet education.
•  Culturally relevant DASH diet education may lead to improvements in dietary behaviors,
knowledge, and self-efficacy in self-management of HTN, providing patients with the tools and
resources needed to empower them for successful participation in self care.
•  Patient health: Positive long-term health outcomes related to controlled BP such as reduced
risk for adverse cardiovascular events and improvements in quality of life and overall health.
•  Healthcare system: Overall cost savings due to the benefits associated with improvements in
HTN management such as decreased hospitalization rates, decreased morbidity and mortality,
and increased reimbursements from CMS given that improved BP and HTN control are
established performance measures.
•  Further longer-term evidenced based projects with more participants are recommended among
this population and region to determine the lasting effects of this intervention on weight, BMI,
SBP, DBP, dietary behaviors, knowledge, and self-efficacy in managing HTN.
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