Black Americans with CKD identify barriers to Dietary Approaches to Stop Hypertension diet
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According to this study, Black Americans with chronic kidney disease perceive the Dietary Approaches to Stop Hypertension diet as a healthy and culturally compatible diet that includes challenges.
Further, researchers noted diet in Black adults is not uniform and interventions should be person centered.
“Black Americans are disproportionately burdened by hypertension, chronic kidney disease (CKD) and cardiovascular disease. The Dietary Approaches to Stop Hypertension eating plan (DASH) improves hypertension1 and is associated with favorable CKD and cardiovascular disease outcomes,” Crystal C. Tyson, MD, MHS, from the division of nephrology at Duke University School of Medicine in Durham, North Carolina, and colleagues wrote. “Whereas prior studies have sought to determine barriers to DASH adherence in individuals with normal kidney function, studies to assess barriers in individuals with CKD have not been conducted.”
In a qualitative study, researchers examined perceptions about DASH, its cultural compatibility and barriers, and facilitators to DASH adherence in 22 patients (the median age was 61 years; 59% were women; 100% were Black Americans; 19% had hypertension). All patients had stage 3 to 4 CKD, and they visited an outpatient primary care or nephrology clinic between November 2019 and March 2020.
Using Research Electronic Data Capture, researchers invited 987 potentially eligible patients to complete an online screening questionnaire. Researchers held focus group discussions from December 2019 to January 2020 that were approximately 90 minutes each. Patients with stage 3 CKD participated in a different focus group than those with stage 4 CKD. Following March 2020, researchers conducted individual telephone interviews to collect data from the remaining patients.
Interviews consisted of semi-structured, open-ended questions to determine patients’ opinions regarding DASH. Additionally, to determine the cultural compatibility of DASH, researchers asked patients to react to the statement, “DASH is not an African American diet because it doesn’t take into account cultural traditions or food preferences.” Researchers did not define “African American diet.” Researchers used a five-stage approach that included familiarization, identifying a thematic framework, indexing, charting and mapping, and interpretation to complete a thematic analysis.
Analyses revealed Black Americans perceived DASH as culturally compatible based on three themes: Black Americans already eat DASH-recommended foods; recipes can be modified; and diet is not uniform among Black Americans. Patients identified barriers to DASH adherence as unfamiliarity with serving sizes, poor cooking skills, unsupportive household members and high cost of healthy food. In fact, 52% reported they “rarely” had leftover money after paying monthly bills to purchase healthy food.
“Black adults with CKD consume diverse diets that are influenced by several factors, including personal taste preferences, familial norms, local customs, geographic location, intrinsic and extrinsic cultural influences and CKD-specific factors,” Tyson and colleagues wrote. “Interventions aimed to improve adherence to DASH among Black Americans will have a broader reach and may be more effective if they center on person-level, rather than stereotypical culture-level, adaptations.”
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