Multiethnic and Multilingual Patients’ Perspectives on Hypertension Diagnosis, Education, Management, and Socioeconomic Factors Within the Safety Net

BACKGROUND: Understanding the clinical, self-management, and resource needs of low-income, multilingual, racially and ethnically diverse safety-net patients with hypertension can guide interventions to improve outcomes in under-resourced communities. OBJECTIVE: Explore barriers and contributors to equitable hypertension care. DESIGN: We conducted semi-structured virtual focus groups during April 2022 to April 2023. PARTICIPANTS: Los Angeles safety-net patients with hypertension (or their caregivers) self-identifying as Latino, Black/African American, Filipino, Korean, and Chinese were eligible; these groups had the lowest blood pressure control rates within a large public safety-net healthcare system. APPROACH: We analyzed transcripts using reflexive thematic analysis. RESULTS: Nine focus groups (43 hypertensive participants) across 5 racial/ethnic groups and 5 languages included three Latino (n = 13), two Black (n = 11), two Chinese (n = 12), one Filipino (n = 4), and one Korean (n = 3) groups. Most patients (70%) received care through a large public healthcare system, 19% at FQHCs, and 6% elsewhere. Thirty-seven percent were over 65, 91% saw a doctor last year, 77% were very low-income, 72% were foreign-born, and 58% preferred a language other than English. Themes illustrate opportunities to achieve equitable hypertension care and management: (1) diagnosis acceptance (gradually processing diagnosis, risk appreciation driving self-management); (2) desire for personalized guidance (guidance needed for reducing medication concerns, preference for solution-focused care, guidance on real-world lifestyle change strategies, physical mobility/disability/mental health limiting self-care); (3) clinical factors (clinical follow-through being primarily patient-initiated, comprehensive clinical support needs, variably accessible provider communication); and (4) community support environments (insufficient resource awareness or access, desires for social support). CONCLUSIONS: Understanding patient experiences can lead to specific, effective, culturally appropriate multilevel interventions for patients, providers, and systems to address the multiple factors affecting hypertension management. We use our findings to outline actionable primary care strategies and case studies for multilevel interventions.