| Hispanic demographics |
| Increase awareness of changing demographics, including diversity of Hispanic background groups |
Increase and standardize health research, electronic health records, and other surveillance mechanisms to include greater granularity and disaggregation of Hispanic subgroups Emphasize workforce development by partnering with organizations (such as the Association of American Medical Colleges and National Board of Public Health Examiners) to ensure that future health professionals have an opportunity to learn and appreciate the complex Hispanic experience, including cultural sensitivity training Provide training of health professionals to provide culturally proficient healthcare services to Hispanics Educate health professionals to recognize the importance of the sociocultural and behavioral determinants of health Collaborative studies should document health outcomes, risk factors, and behaviors according to the Hispanic countries of origin and include Hispanics with varying lengths of residence in the United States to capture the influence of immigration and acculturation* Improve and standardize Hispanic population data collection, especially for race, age, sex, religion, SES, primary language, generational status, geographic location and country of origin
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| SES of the Hispanic population |
| Reduce health disparities |
Research is needed on the individual and combined influence that SES has on CVH among Hispanics* Research is needed on the impact that community and neighborhoods have on CVH among Hispanics* Improve access to care for the uninsured and how to handle CVD identified among individuals who do not have access to health insurance or healthcare services
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| Language, health literacy, and patient-provider relationships |
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| Reduce barriers in health care |
Studies need to address, in advance, how research outcomes will be communicated to Hispanic participants Improve the communication strategies and health literacy of Hispanics, particularly utilizing knowledge, skills, and information relevant to CVH promotion Incorporate culturally proficient healthcare services to Hispanics, including the promotion of Spanish-speaking and culturally sensitive physicians and allied health professionals and the integration of community navigators or lay health workers (Promotoras)
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| Hispanics and race |
| Increase awareness of racial diversity among Hispanics |
Epidemiological studies in Hispanics should capture information and materials relevant to race Conduct empirical research on the cultural construction of race among Hispanics, including experiences of perceived discrimination to identify the consequences of these experiences for CVH Incorporate genetic profiling via ancestry to possibly provide further answers to understanding the ways in which race impacts CVD among Hispanics
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| Improve measurement of race and ethnicity to support a greater understanding of Hispanic diversity |
| Prevalence of CVD risk factors; Hispanic CVD incidence and prevalence |
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| Increase awareness of health disparities for CVD and stroke |
Increase the Latino healthcare workforce to reflect the changing US demography Educate health professionals and health planning organizations about the potential underestimation of CVD risk in Hispanic patients CVD prevention should begin earlier in life; to this end, the healthcare system needs to broaden its scope to focus on implementing effective health promotion and disease-prevention strategies within Hispanic communities and within public schools Implement systems of primary and secondary CVD prevention among Hispanic populations, which can serve as a model for other disadvantaged individuals and communities Promote a healthy lifestyle and improve healthcare access and screening for hypertension and diabetes mellitus Recommend that USPSTF clinical recommendations be adapted to screen for CVD risk factors among Hispanics given the earlier onset/wider prevalence Emphasize workforce development by cultivating a team approach with professionals prepared in medicine, nursing, pharmacy, nutrition, social work, and other disciplines who are culturally proficient and ready to tackle CVD disparities Recognize that racial/ethnic disparities in CVD and stroke care exist for Hispanics and seek solutions at the patient level and at the healthcare system level Implement educational CVD and stroke prevention programs among Hispanics to promote the recognition of risk factors and the warning symptoms of strokes and heart attacks
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| Emphasize workforce development to improve CVD prevention and promote CVH |
| Hispanic paradox |
| Highlights how little we know about Hispanics |
The presence of an Hispanic paradox needs to be evaluated in all Hispanic subgroups,416 including populations that are often difficult to enumerate, such as recent immigrant and migrant populations The Hispanic paradox needs to be evaluated for all the leading causes of Hispanic morbidity and mortality and for chronic and infectious conditions Examine whether Hispanics have slower disease processes, are less likely to have certain diseases, or are more likely to recover than non-Hispanics Evaluate whether the Hispanic paradox for these conditions is present among US Hispanics and Hispanic populations abroad; if a paradox truly exists, health research must identify ways to maintain health across all segments of the US population Counteract potential negative effects of the Hispanic paradox on health policy, such as underestimating the cardiovascular needs of Hispanic patients
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| Psychosocial factors and health behaviors |
| Advance our understanding of the acculturative process and its potential impact on CVH of the Hispanic population |
Improvement of acculturation measurements Further research is needed to identify the mechanisms that link acculturation to health outcomes,416 including disease risk communication, while also addressing the impact of acculturation and acculturative stress on CVH Identify the relationship to acculturation to social behaviors (including social interaction within families and the larger society) Broaden the analysis of social support among Hispanics to other aspects of CVH (beyond physical activity) Determine how might social support be related to acculturation among Hispanics and the joint and individual effect of social support on CVH Understand the prevalence and reasons for CAM use among Hispanics, as well as how CAM use may facilitate or impede CVH prevention and treatment Recommend that healthcare providers ask Hispanic patients about CAM use in a nonjudgmental manner
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| Commonalities in culture and beliefs |
| Increase awareness of the influence of culture, including Hispanic subgroup diversity |
Educate health professionals and researchers that culture can be an asset rather than a risk or underlying cause of the burden of disease among Hispanics When culture is identified as a factor in the behavior of focus, researchers should provide their definition of culture and identify the measures used to operationalize the concept Develop guidelines for the use of culture in population health science A repository of available culturally appropriate research instruments and protocols applicable to Hispanic populations should be developed and maintained416 Provide training for health professionals in cultural competence, cultural tailoring, cultural sensitivity, or cultural literacy that can draw on patient beliefs and values to frame CVH information, health education campaigns, and behavioral interventions Integrate cultural knowledge into communication styles for culturally based and patient-centered care Provide training for Hispanic and non-Hispanic researchers in cultural issues and norms relevant to the populations being studied Support research that focuses on the translation and dissemination of evidence-based practices that support CVH; evaluate and test whether these practices work in Hispanic communities
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| Emphasize workforce development for a culturally competent healthcare system |
