Perceptions of Dutch Health Professionals about Ethnic Disparity in Hypertension Control

Abstract

Background: In pace with globalization, the ethnic disparity in hypertension control is becoming a threat to positive outcomes in global health. Within countries with high ethnic diversity, for example, the Netherlands, ethnic disparity is a significant issue. The reasons for ethnic disparity in hypertension control are not well understood. Dutch health professionals directly interface with the health system and patients. As such, evaluating Dutch health professionals’ perceptions plays a pivotal role in understanding ethnic disparity in hypertension control. Although collecting ethnicity information may be useful in studying and reducing ethnic disparity in hypertension control, within the Dutch health system, ethnic information is hardly complete. Additionally, it is important to explore the health professionals’ attitude towards collecting ethnicity information.Methods: This is a cross-sectional mixed-methods study, using both quantitative (online survey) and qualitative (in-depth interviews) data collection methods. Convenient and snowball sampling were utilized when identifying potential participants practicing in the Dutch urban Randstad area. After sending out invitation letter to potential participants through email, 77 online surveys were collected using Qualtrics. In addition, 13 in-depth interviews were conducted.Results: Respondents were mainly general practitioners (80.5%), female (58.4%), and predominantly White Dutch (76.6%)—noting that in Amsterdam, 48% of the general population is White Dutch (Republiek Allochtonie, 2016). Most providers (79.2%) had ethnically diverse patients. Nearly all the respondents (98.8%) reported the collection of patients’ ethnicity data as important. The most frequently cited reason was that these data can help respondents to better evaluate patients’ risk and make better treatment plans. While 81.3% of the participants reported that ethnic disparity in hypertension control was a problem in the Netherlands, only 55.8% thought it was a problem among their own patients. The argument they claimed was that compared with the general situation in big cities in the Netherlands, their own patients were not that ethnically diverse. Also, some of them reported that they performed better than other health professionals. The majority of health professionals placed more emphasis on the contribution of patient-related factors to ethnic disparity in hypertension control compared with health professional-related factors. They argued that in the end it was patients who should take the medication and change their unhealthy lifestyle, so the biggest responsibility was on them. The program most frequently cited as “Very effective” was aimed at improving health professionals’ awareness of ethnic disparity in hypertension control (50.6%). Nearly 88.5% of participants acknowledged the ethnic- specific training they received in reducing ethnic disparity in hypertension control. Other strategies, including programs targeting at nurses, were also recommended by participants in reducing ethnic disparity in hypertension control.Conclusion: The majority of health professionals supported collecting ethnicity information and acknowledged it could help reduce ethnic disparity in hypertension control. Therefore, the health system in the Netherlands should launch programs facilitating the collection of ethnicity information in primary care. However, few studies have assessed patients’ attitudes towards having their ethnicity information collected, and more research will be needed. Also, as nurses spend more time working with hypertensives than doctors and other care providers, they should be the target population in future studies assessing health professionals’ knowledge, attitudes, and perceptions on ethnic disparity in hypertension care.