Healthier Blood Pressure for Queer and Trans Pacific Islanders

In the face of psychosocial stressors, such as systemic discrimination and acts of violence, the manifestation of physical and mental health challenges continues to deepen health inequities among LGBTQIA+ communities1(link opens in new window). For Queer and Transgender Pacific Islander (QTPI) individuals, barriers to quality health care related to gender identity and sexual orientation are magnified by a sparsity of providers that reflect their culture, health literacy gaps due to a lack of linguistically appropriate materials and historical trauma.

Health care providers aren’t often presented with opportunities to develop a skillset to work with LGBTQIA+ patients effectively. This can make it difficult to unlearn assumptions and challenge biases that negatively impact the patient care experience. Consequently, nearly 70% of gender diverse adults report having experienced some form of discrimination from providers and 25% of transgender adults report being denied care altogether2(link opens in new window).

When combined, this is a dangerous equation that not only lends to a deep mistrust in the medical system but can also impact health outcomes, including an elevated likelihood of cardiovascular disease risk factors like high blood pressure3(link opens in new window). In King County, Native Hawaiian and Pacific Islander residents experience heart disease at over twice the rate of the county average4(link opens in new window). And the rate of LGBTQIA+ adults who report lacking health insurance is nearly double the average5(link opens in new window).

group of three people looking on as one woman takes her blood pressureUTOPIA Washington, a grassroots organization led by trans women of color, identifying as transgender and/or fa'afafine that works to uplift the health and well-being of QTPI and LGBTQIA+ communities of color, established their Mapu Maia clinic to fill a gap in affordable, gender-affirming, culturally-aligned health care services. Mapu Maia translates to “a place to rest” in Samoan and fittingly, their care model was intentionally designed to offer refuge in a setting where many 2SLGBTQIA+ (Two-Spirit (a term used by Native American individuals who identify as having both a masculine and a feminine spirit), Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Asexual) community members have felt invalidated and unsafe. The Mapu Maia team operates a rotating schedule of services relevant to 2SLGTBQIA+ health including HIV/PrEP navigation, hormone therapy, vaccinations and more. As of April 2023, Mapu Maia welcomes community members into a colorful, newly renovated space complete with state-of-the-art equipment, private exam rooms and an on-site lab.

To help address high rates of uncontrolled high blood pressure (hypertension) among QTPI communities, the American Heart Association is growing our existing collaboration with UTOPIA Washington to include a self-measured blood pressure (SMBP) screening, education and referral initiative that expands their clinic’s service offerings. This community-informed program launched in March 2023 and has the potential to equip over 1,400 Kent residents to monitor their high blood pressure at home and connect with providers for follow up care.

The American Heart Association drafted and proposed a comprehensive blood pressure education and self-measurement program after UTOPIA’s clinic team reported a spike in patients whose blood pressure readings revealed elevated numbers. Additionally, an increasing number of Mapu Maia patients report smoking which can exacerbate hypertension and the risk of heart disease and stroke.

With training provided by the American Heart Association, a volunteer Doctor of Nursing Practice (DNP) student and HealthPoint (low-barrier health centers that serve low-income and uninsured individuals), UTOPIA’s Mapu Maia team received training on accurate blood pressure measurement technique so they can train community members to take their blood pressure at home. Clinic staff offer screening opportunities to identify individuals with high blood pressure during a rotation of health clinics as well as through their Warrior of Wisdom peer support group that connects QTPI elders through culturally relevant social connection and skill building. Community members can also self-identify as hypertensive by answering qualifying questions added to UTOPIA’s intake forms and receive follow up about the opportunity to participate in home monitoring.

“UTOPIA’s partnership with the American Heart Association and HealthPoint has been fruitful. Since the start of our SMBP training, it has greatly impacted how we interact with our community. This in turn informs our work. Whether it is educational or programmatic, the training helps us minimize factors that contribute to high blood pressure in our communities. I am proud to say that our care team now provides self-measured blood pressure monitoring as part of our care work, allowing us to expand care and safety support that ultimately impacts how we show up for community,” said Fania Sipili, Community Care Program Manager at UTOPIA Washington.

Screened individuals that have high blood pressure readings are invited to monthly clinics dedicated to hypertension consultation and SMBP enrollment, made possible by support from HealthPoint’s volunteer resident physician and a DNP student who field medical questions and recommend next steps. As part of the intake and return procedure, a pre- and post-survey developed as part of the DNP’s practicum helps assess participants’ understanding of blood pressure values, comfort with home-monitoring and conversing with a care provider and the interest in further interventions. Results are compared after a participant’s involvement in the one-month SMBP program and are used to measure outcomes and adapt program components based on feedback.

Once enrolled, participants are encouraged to focus on healthy habits and twice-daily monitoring, utilizing validated blood pressure devices provided by the American Heart Association. In alignment with our acknowledgement of UTOPIA’s cultural expertise, we worked directly with UTOPIA staff, and provided compensation, to facilitate the translation of educational materials to Samoan to ensure resources are culturally and linguistically appropriate.

Data from the American Heart Association’s Hypertension journal found that rates of LGBTQIA+ adults with high blood pressure that aren’t taking their medication are significantly higher than heterosexual adults6. This may be due to barriers including a lack of trusted relationships with medical teams. Without proper management, this puts community members at greater risk of heart disease and stroke. 

Participants are provided a blood pressure tracking log which they are instructed to share with their health care provider to strategize next steps according to their results. Depending on the participant’s blood pressure reading at initial screening and at two-week follow up intervals, Mapu Maia staff also provide direct referrals to the LGBTQ+ health resident physician at HealthPoint, according to protocols defined by the American Heart Association and HealthPoint, for ongoing treatment and counsel. For individuals without established care teams, HealthPoint is able to offer low-cost, sliding scale payment options to make care more accessible.

“My favorite thing about this program is not only the educational aspect, but our community being able to see, read, and understand important information in their own language. This not only strengthens the importance of this program, but it also showcases the American Heart Association’s intention in ensuring that we can translate our own material in a way that honors the meaning of the message and the cultural aspect of our work,” said Trina Tuimalealiifano, Community Care Program Coordinator at UTOPIA Washington.

To increase visibility of the blood pressure program ahead of the spring launch, UTOPIA incorporated the American Heart Association into their Transgender Week of Awareness services in 2022. A nurse educator supported our blood pressure demonstrations to educate the community about proper measurement technique and recruit potential participants into the SMBP program. With the support of a mobile dental van that incorporated blood pressure measurement into their intake protocol, we were able to identify someone with dangerously high blood pressure exhibiting potential stroke symptoms and connect them to emergency care.

The American Heart Association facilitates monthly check-ins to actively solicit feedback, insight and cultural expertise from Mapu Maia staff to adapt the program to address evolving needs and ensure it resonates well with participants.

Studies show that when patients receive care from providers that represent their culture, patient comfort levels and receptibility to treatment increase, improving overall patient outcomes7. In efforts to build care teams that reflect their communities, UTOPIA has recently welcomed a volunteer doctor with Pacific Islander heritage and volunteer nurse with Hawaiian heritage that provide a consistent presence in the clinic each week. Their lived experiences and shared cultural values lend to the strong rapport they’ve built with patients.

This self-measured blood pressure program provides a replicable and equitable solution to help LGBTQ+ Pacific Islander individuals rebuild trust in the health care system and access preventative health services. In return, UTOPIA’s Mapu Maia community clinic presents an opportunity for local health care leaders to embrace and support grassroots models of individually tailored care that are responsive to the complexity of LGBTQ+ health needs.