Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Inhibitors and enablers of physical activity in multiethnic hypertensive patients: qualitative study

Abstract

Regular physical activity (PA) can reduce blood pressure, but hypertensive patients in ethnic minority populations are often inactive. The objective of this qualitative study was to explore inhibitors and enablers of PA from the perspective of hypertensive Ghanaian, African-Surinamese and White-Dutch patients in Amsterdam, The Netherlands. In-depth individual interviews with 46 patients were analysed for thematic content, using Maxqda software. All three groups mentioned their hypertension, the presence of other health conditions, lack of priority, lack of social support, limited financial resources or access to PA facilities as inhibitors for maintaining or increasing their level of PA. Common enablers included health-related incentives, support from physicians or family and having physically demanding work. Specific inhibitors only mentioned by Ghanaians and Surinamese included inexperience with recommended ‘Western’ activities (cycling), little access to their habitual forms of PA, cultural preferences for large body sizes, unfamiliarity with the host country and the pressure of social demands from the Dutch society and their own communities. Specific enablers for Ghanaians and Surinamese included access to community or church-based support groups. These patient-identified inhibitors and enablers can be a useful framework for promoting PA in hypertensive patients, particularly from immigrant groups. Physicians may build their advice on the identified enablers and tackle the inhibitors.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Cappuccio FP . Ethnicity and cardiovascular risk: variations in people of African ancestry and South Asian origin. J Hum Hypertens 1997; 11: 571–576.

    Article  CAS  Google Scholar 

  2. Raleigh VS . Diabetes and hypertension in Britain's ethnic minorities: implications for the future of renal services. BMJ 1997; 314: 209–213.

    Article  CAS  Google Scholar 

  3. Douglas JG, Bakris GL, Epstein M, Ferdinand KC, Ferrario C, Flack JM et al. Management of high blood pressure in African Americans: consensus statement of the Hypertension in African Americans Working Group of the International Society on Hypertension in Blacks. Arch Intern Med 2003; 163: 525–541.

    Article  Google Scholar 

  4. Agyemang C, Bindraban N, Mairuhu G, Montfrans G, Koopmans R, Stronks K . Prevalence, awareness, treatment, and control of hypertension among Black Surinamese, South Asian Surinamese and White Dutch in Amsterdam, The Netherlands: the SUNSET study. J Hypertens 2005; 23: 1971–1977.

    Article  CAS  Google Scholar 

  5. Agyemang C, Bruijnzeels MA, Owusu-Dabo E . Factors associated with hypertension awareness, treatment, and control in Ghana, West Africa. J Hum Hypertension 2005; 20: 67–71.

    Article  Google Scholar 

  6. van den Born BJ, Koopmans RP, Groeneveld JO, van Montfrans GA . Ethnic disparities in the incidence, presentation and complications of malignant hypertension. J Hypertens 2006; 24: 2299–2304.

    Article  CAS  Google Scholar 

  7. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 2003; 289: 2560–2571.

    Article  CAS  Google Scholar 

  8. Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF et al. British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary. BMJ 2004; 328: 634–640.

    Article  Google Scholar 

  9. Whelton SP, Chin A, Xin X, He J . Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med 2002; 136: 493–503.

    Article  Google Scholar 

  10. Serour M, Alqhenaei H, Al-Saqabi S, Mustafa AR, Ben-Nakhi A . Cultural factors and patients' adherence to lifestyle measures. Br J Gen Pract 2007; 57: 291–295.

    PubMed  PubMed Central  Google Scholar 

  11. Hayes L, White M, Unwin N, Bhopal R, Fischbacher C, Harland J et al. Patterns of physical activity and relationship with risk markers for cardiovascular disease and diabetes in Indian, Pakistani, Bangladeshi and European adults in a UK population. J Public Health 2002; 24: 170–178.

    Article  Google Scholar 

  12. Kruger J, Kohl HW . Prevalence of regular physical activity among adults United States, 2001 and 2005. JAMA 2008; 299: 30–32.

    Article  CAS  Google Scholar 

  13. Agyemang C, van Valkengoed I, Koopmans R, Stronks K . Factors associated with hypertension awareness, treatment and control among ethnic groups in Amsterdam, The Netherlands: the SUNSET study. J Hum Hypertens 2006; 20: 874–881.

    Article  CAS  Google Scholar 

  14. Whitlock EP, Orleans CT, Pender N, Allan J . Evaluating primary care behavioral counseling interventions: an evidence-based approach. Am J Prev Med 2002; 22: 267–284.

    Article  Google Scholar 

  15. Stokols D . Translating social ecological theory into guidelines for community health promotion. Am J Health Promot 1996; 10: 282–298.

    Article  CAS  Google Scholar 

  16. Centers for Disease Control and Prevention. Social-Ecological Model. http://www.cdc.gov/nccdphp/dnpa/obesity/state_programs/se_model.htm. . Accessed on 8 May 2009.

  17. De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J et al. European guidelines on cardiovascular disease prevention in clinical practice. Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of eight societies and by invited experts). Eur Heart J 2003; 24: 1601–1610.

    Article  Google Scholar 

  18. Smulders YM, Burgers JS, Scheltens T, van Hout BA, Wiersma T, Simoons ML . Clinical practice guideline for cardiovascular risk management in The Netherlands. Neth J Med 2008; 66: 169–174.

    CAS  PubMed  Google Scholar 

  19. Fleury J, Lee SM . The social ecological model and physical activity in African American women. Am J Community Psychol 2006; 37: 129–140.

    Article  Google Scholar 

  20. Agyemang C, Bhopal R, Bruijnzeels M . Negro, Black, Black African, African Caribbean, African American or what? Labelling African origin populations in the health arena in the 21st century. J Epidemiol Community Health 2005; 59: 1014–1018.

    Article  Google Scholar 

  21. Caperchione CM, Kolt GS, Mummery WK . Physical activity in culturally and linguistically diverse migrant groups to Western society: a review of barriers, enablers and experiences. Sports Med 2009; 39: 167–177.

    Article  Google Scholar 

  22. Lawton J, Ahmad N, Hanna L, Douglas M, Hallowell N . ‘I can't do any serious exercise’: barriers to physical activity amongst people of Pakistani and Indian origin with type 2 diabetes. Health Educ Res 2006; 21: 43–54.

    Article  CAS  Google Scholar 

  23. Sriskantharajah J, Kai J . Promoting physical activity among South Asian women with coronary heart disease and diabetes: what might help? Fam Pract 2007; 24: 71–76.

    Article  Google Scholar 

  24. Pope C, van Royen P, Baker R . Qualitative methods in research on healthcare quality. Qual Saf Health Care 2002; 11: 148–152.

    Article  CAS  Google Scholar 

  25. Pope C, Ziebland S, Mays N . Qualitative research in health care. Analysing qualitative data. BMJ 2000; 320: 114–116.

    Article  CAS  Google Scholar 

  26. Mays N, Pope C . Qualitative research in health care. Assessing quality in qualitative research. BMJ 2000; 320: 50–52.

    Article  CAS  Google Scholar 

  27. Wiersma T, Walma EP, Thomas S, Assendelft WJ . Summary of the practice guideline ‘Hypertension’ (third division) from the Dutch College of General Practitioners. Ned Tijdschr Geneeskd 2004; 148: 923–931.

    PubMed  Google Scholar 

  28. Aspinall PJ . Operationalising the collection of ethnicity data in studies of the sociology of health and illness. Sociol Health Illn 2001; 23: 829–862.

    Article  Google Scholar 

  29. Britten N . Qualitative research: qualitative interviews in medical research. BMJ 1995; 311: 251–253.

    Article  CAS  Google Scholar 

  30. Beune EJAJ, Haafkens JA, Schuster JS, Bindels PJE . Under pressure': how Ghanaian, African-Surinamese and Dutch patients explain hypertension. J Hum Hypertens 2006; 20: 946–955.

    Article  CAS  Google Scholar 

  31. Beune EJ, Haafkens JA, Agyemang C, Schuster JS, Willems DL . How Ghanaian, African-Surinamese and Dutch patients perceive and manage antihypertensive drug treatment: a qualitative study. J Hypertens 2008; 26: 648–656.

    Article  CAS  Google Scholar 

  32. Moss-Morris R, Weinman J, Petrie K, Horne R, Cameron L, Buick D . The revised illness perception questionnaire (IPQ-R). Psychol Health 2002; 17: 1–16.

    Article  Google Scholar 

  33. Kleinman A, Eisenberg L, Good B . Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med 1978; 88: 251–258.

    Article  CAS  Google Scholar 

  34. Strauss A . Qualitative Analysis for Social Scientists. Cambridge University Press: New York, 1987.

    Book  Google Scholar 

  35. Denzin NK, Lincoln YS . Handbook of Qualitative Research. Sage Publications: Thousand Oaks, London, New Delhi, 1994.

    Google Scholar 

  36. MAXqda. http://www.maxqda.com/maxqda-eng/index.htm. Accessed on 16 December 2008.

  37. Mays N, Pope C . Qualitative research: rigour and qualitative research. BMJ 1995; 311: 109–112.

    Article  CAS  Google Scholar 

  38. McLeroy KR, Bibeau D, Steckler A, Glanz K . An ecological perspective on health promotion programs. Health Educ Q 1988; 15: 351–377.

    Article  CAS  Google Scholar 

  39. Im EO, Choe MA . Korean women's attitudes toward physical activity. Res Nurs Health 2004; 27: 4–18.

    Article  Google Scholar 

  40. Stevens J, Kumanyika SK, Keil JE . Attitudes toward body size and dieting: differences between elderly black and white women. Am J Public Health 1994; 84: 1322–1325.

    Article  CAS  Google Scholar 

  41. Liburd LC, Anderson LA, Edgar T, Jack Jr L . Body size and body shape: perceptions of black women with diabetes. Diabetes Educ 1999; 25: 382–388.

    Article  CAS  Google Scholar 

  42. Yancey AK, Simon PA, McCarthy WJ, Lightstone AS, Fielding JE . Ethnic and sex variations in overweight self-perception: relationship to sedentariness. Obesity (Silver Spring) 2006; 14: 980–988.

    Article  Google Scholar 

  43. Ofosu HB, Lafreniere KD, Senn CY . Body image perception among women of African descent: a normative context? Fem Psychol 1998; 8: 303–323.

    Article  Google Scholar 

  44. Anderson LA, Eyler AA, Galuska DA, Brown DR, Brownson RC . Relationship of satisfaction with body size and trying to lose weight in a national survey of overweight and obese women aged 40 and older, United States. Prev Med 2002; 35: 390–396.

    Article  Google Scholar 

  45. Kumanyika S, Wilson JF, Guilford-Davenport M . Weight-related attitudes and behaviors of black women. J Am Diet Assoc 1993; 93: 416–422.

    Article  CAS  Google Scholar 

  46. Duda RB, Jumah NA, Hill AG, Seffah J, Biritwum R . Assessment of the ideal body image of women in Accra, Ghana. Trop Doct 2007; 37: 241–244.

    Article  Google Scholar 

  47. Campbell MK, Hudson MA, Resnicow K, Blakeney N, Paxton A, Baskin M . Church-based health promotion interventions: evidence and lessons learned. Annu Rev Public Health 2007; 28: 213–234.

    Article  Google Scholar 

  48. Whitt-Glover MC, Hogan PE, Lang W, Heil DP . Pilot study of a faith-based physical activity program among sedentary blacks. Prev Chronic Dis 2008; 5: A51.

    PubMed  PubMed Central  Google Scholar 

  49. Paschal AM, Lewis RK, Martin A, Shipp DD, Simpson DS . Evaluating the impact of a hypertension program for African Americans. J Natl Med Assoc 2006; 98: 607–615.

    PubMed  PubMed Central  Google Scholar 

  50. Lip GYH, Barnett AH, Bradbury A, Cappuccio FP, Gill PS, Hughes E et al. Ethnicity and cardiovascular disease prevention in the United Kingdom: a practical approach to management. J Hum Hypertens 2007; 21: 183–211.

    Article  CAS  Google Scholar 

  51. National Institute for Health & Clinical Excellence. Four commonly used methods to increase physical activity: brief interventions in primary care, exercise referral schemes, pedometers and community-based exercise programmes for walking and cycling. Public Health Intervention Guidance no. 2006 Mar. Report No.: 2.

  52. Caspersen C, Powell K, Christenson G . Physical activity, exercise, and physical fitness: definitions and distinctions of health-related research. Public Health Reports 1985; 100: 126–131.

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank Olga Lackamp, Karien Stronks and Dick Willems, who took part in the research group of this study, and Mary Nicolaou for the helpful comments on an earlier version of this paper. We thank ZonMw, The Netherlands organisation for Health Research and Development, for financing this study. Most of all, we are grateful to all participants for sharing their experiences.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to E J A J Beune.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Beune, E., Haafkens, J., Agyemang, C. et al. Inhibitors and enablers of physical activity in multiethnic hypertensive patients: qualitative study. J Hum Hypertens 24, 280–290 (2010). https://doi.org/10.1038/jhh.2009.61

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2009.61

Keywords

This article is cited by

Search

Quick links