The patient understands spoken English, and seems comfortable conversing in this language. However, the patient's wife does not speak English, and all written and spoken communication with her must be in Spanish. The preference for Spanish in both the husband and wife suggests only a moderate degree of acculturation (link to acculturation module), and the patient is likely to hold traditional Latin values and attitudes.
1.Adherence to antihypertensive treatment: This topic is best addressed in a meeting between the patient and physician alone. The validity of the patient's concern about impotence must be acknowledged, but it should be stressed that there can be causes of decreased libido other than antihypertensive medication. Not all antihypertensives affect sexual function, and the one prescribed to the patient is not known to cause impotence. The patient should be encouraged to try taking the ACE inhibitor as prescribed for a brief period (2-4 weeks) and report back to the physician any adverse effects. He should be reassured that there are other medications that can be prescribed to control blood pressure if the one he is on is not satisfactory.
2.Diet: Since the wife is responsible for preparing family meals, she should be invited to attend a dietary counseling session with her husband. If nutrition counseling cannot be provided in Spanish, she should at least be given written educational materials in Spanish on low-salt, low-fat diets. Since the husband understands English, he can translate verbal information for her during the diet counseling sessions.
3.Alcohol Consumption: It is possible that counseling regarding alcohol consumption will be more effective without the wife present, since in traditional Latin families, the wife is not permitted to interfere with the husband's drinking behavior. The adverse effect of excessive alcohol intake on blood pressure and the patient's risk of heart attack in view of his father's medical history must be stressed. The patient should be asked to cut down to no more than 2 drinks per day.
4.Physical Activity: Physical activity counseling is likely to be most effective over a period of months or even years. The patient works in a relatively sedentary position, and if leisure time physical activity is not part if his lifestyle, he must first be made aware of the health benefits of exercise. Eventually he can be encouraged to begin walking 2-3 time per week, or exercising in his home. The patient is financially able to join a health club, and this can also be proposed to him to get him started with an exercise program.