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Abstract
Background: A chart review at a urological office revealed that Hmong patients present with higher rates of kidney stones, uric acid stones, and complications from kidney stones than non-Hmong patients. In order to ultimately redress this health disparity, a conference of Hmong and non-Hmong health care providers decided that we needed to first understand the pertinent social, cultural, economic, and biological factors contributing to the disparity. This research project sought to elicit Hmong patients and family members' explanatory models, decision-making processes, and experiences with the health care system.
Methods: We conducted in-depth interviews with 10 Hmong kidney stone patients, 11 family members of 9 patients, and 4 traditional healers. All 10 patients had received urological interventions, including ureteroscopy (8), percutaneous lithotomy (5) and nephrectomy (2). Some patients had postponed medical assistance (6) and had refused procedures (4). We qualitatively analyzed the transcribed and translated interviews with an Excel spread sheet and N6 computer software. Results were discussed with patients and a community advisory council.
Results: Hmong concepts of kidney function and explanatory models of kidney stones are a blend of traditional and biomedical concepts. Kidney stones are understood as acute health problems caused by hard substances in water and food that stick to the kidney, which weak kidneys cannot excrete. Kidney stone sufferers do not know they have stones until they pass a stone or they see stones on X-rays, as pain or hematuria are non-specific symptoms. They prefer medications, including herbal medicines, to invasive urological procedures. In making decisions about urological interventions, Hmong patients balance fear of disease (pain and renal failure) with fear of doctors (complications from interventions and anesthesia). While patients have variable balance points to accept interventions, the basic philosophy of "die another day" captures people's preference to act today so as to postpone "death" -whether by disease or procedure - until tomorrow.
Conclusions: These findings identify Hmong patients and family's experiences with this health disparity. This information could be used to increase the Hmong community and patients' knowledge of the disease and decrease their fear of urological interventions. Urologists, primary care providers and community health educators could educate the Hmong community and patients about the recurrent and nearly asymptomatic but potentially life-threatening nature of kidney stones, and...