Health Policy$ense

Promoting Self-care Among African Immigrants with Chronic Diseases

Cultural and Structural Factors

As African immigrants settle in Europe and the United States, they experience rising rates of chronic diseases such as diabetes and hypertension, at levels not seen in their home countries. Self-care is key to managing these chronic illnesses, but this population may face cultural and societal challenges to adherence to recommended health practices. In the Journal of Advanced Nursing, we report on the results of a systematic review, finding that an interplay of cultural and structural factors influences the self-care practices of African immigrants with chronic diseases. While cultural identity is a powerful influence, African immigrants also report systemic barriers to adopting self-care recommendations.

Onome Osokpo, MSN, RN, MSc
Onome Henry Osokpo, PhD, MSc, MSN, RN is an LDI Associate Fellow, Provost Postdoctoral Fellow for Academic Diversity, and Postdoctoral Research Fellow in the School of Nursing at the University of Pennsylvania 

Maintaining cultural identity was both a driver and constraint to engaging in recommended self-care practices. We found that individual, family, and community expectations and experiences were driving self-care behaviors of African immigrants. Self-care recommendations from providers are likely to be followed if culturally tailored. Support from family and friends facilitated engagement in recommended, culturally-accepted self-care practices.

Medication adherence
Family members facilitated medication adherence by sending reminders to take medicines and/or paying for medications. In addition to adhering to prescribed medications, African immigrants placed high importance on alternative medicine because such remedies are perceived as natural, harmless, low-cost, easily accessible, and efficacious.

Diet
Social norms around eating and cultural taste preferences were barriers to adhering to unfamiliar dietary recommendations. African immigrants sometimes used creative strategies to facilitate adherence to prescribed diets, including mixing recommended foods with African soup. Family members and friends also encouraged dietary adherence by assisting with grocery shopping and meal preparation.

Structural factors
These cultural factors do not operate in isolation. Other societal factors create barriers to self-care as well, including lack of health insurance, cost of health care, unemployment, financial limitations, lack of transportation, immigration status, and linguistic challenges. Additionally, information and recommendations regarding self-care were ignored if they were either too technical or of poor quality. Effective physician-patient communication facilitated adherence to recommended self-care practices.

These insights can help clinicians develop culturally appropriate recommendations for self-care, and address the structural barriers to adherence. Certain self-care practices (for example, eating traditional foods) are central to maintaining cultural and community identity; recommended behaviors that are outside these cultural expectations or identities may not be followed if the benefits are not clearly articulated. Western demands for culturally inappropriate behaviors will likely be met with subtle resistance. That said, systemic challenges often supersede the influence of cultural factors on self-care in this population. Health care providers and policymakers should understand and consider the interplay of these factors when developing and implementing policies to advance health equity.