Nurse practitioners (NPs) form the key to providing culturally competent care, which reduces health disparities and improves outcomes for Asian American patients, according to research presented at the American Association of Nurse Practitioners (AANP) annual conference, held from June 17 to 22, 2025, in San Diego, California.

Sun Jones, DNP, RN, FNP-BC, FAANP, and Sun Wright, DNP, RN, FNP-C, discussed the top health related issues that Asian Americans face, including elevated risk for certain cancers, cardiovascular disease (CVD), tuberculosis, diabetes, mental health conditions, hepatitis, and blood disorders.

Managing these conditions starts with providing culturally competent care, Drs. Wright and Jones explained. To build trust with patients and their families, NPs should gather information about their patients’ ethnicity, family history, and genetic background. The American Heart Association (AHA) guidelines make clear distinctions among different Asian ethnicities. For example, people of South Asian descent – those from Bangladesh, India, Nepal, Pakistan, and Sri Lanka – have a higher risk of developing heart disease than the general American population, according to the AHA. People with Japanese backgrounds are “more likely to be sensitive to statin drugs used to treat cholesterol and may require lower dosing,” said the AHA.

“Each Asian [country] has its own unique culture, customs, and beliefs, so providers [should make an effort to] understand what they believe and provide better care instead of using a one-size-fits-all type of care,” Dr Wright said in an interview with The Clinical Advisor.

Providing tailored, culturally sensitive care for Asian American patients includes applying evidence-based screening and treatment protocols that are specific to each patient’s risk profile. It is also helpful for providers to keep in mind that Asian American patients may prefer naturopathic or holistic treatments in conjunction with Western medicine, Dr Jones explained. 

“Some of the naturopathic methods, like cinnamon and ginseng, are known to decrease blood sugar; they may be more apt to use those kinds of over-the-counter [herbs and spices],” Dr Jones said. “You have to really understand their actions, and then honor their choices.”

Providing Culturally Competent Diabetes Care for Asian Americans

For patients with prediabetes, early detection and intervention with lifestyle modifications are crucial to prevent adverse outcomes. Patients should be screened for diabetes if their body mass index (BMI) is 23 or higher, which is lower than the 25 or higher BMI recommended for other ethnicities. They have any additional risk factors, such as family history of diabetes, hypertension, physical inactivity, a history of gestational diabetes, high-density lipoprotein (HDL) less than 35 mg/dL, or triglycerides higher than 250 mg/dL.

Clinicians should initiate treatment with metformin for patients with diabetes unless it is contraindicated. Newer medications, such as glucagon-like peptide-1 (GLP-1) receptor agonists or sodium-glucose cotransporter-2 (SGLT2) inhibitors, may be appropriate if beneficial to the patient’s cardiovascular and renal health, because Asian Americans are at higher risk for both diseases.

Several barriers may prevent Asian Americans from accessing care for diabetes. To mitigate language barriers, clinicians can offer translated patient education materials or an interpreter.

Culturally, stigma and shame sometimes prevent Asian Americans from seeking medical care. Reducing stigma, as well as providing ethnically appropriate dietary recommendations and lifestyle modifications, are ways that clinicians can provide culturally sensitive diabetes care.

Lowering CVD Risk in Asian American Patients

“A lot of Asians are very thin, and so people just assume they are very healthy,” Dr. Jones said. “However, even though they’re thin on the outside, they have a lot of visceral fat, which increases their risk for cardiovascular disease. Also, a lot of people smoke. Asian men are especially heavy smokers, so they are at higher risk for cardiovascular disease [CVD] and lung cancer.”

To screen patients for CVD, Drs Jones and Wright recommend conducting lipid and cardiac panels, assessing the patient’s BMI and blood pressure, and taking their family history.

There are medical treatments and lifestyle changes patients can make to manage their CVD risk. Lifestyle changes include smoking cessation, as well as reducing sugar, sodium, and fat intake, while increasing physical activity and fiber intake.

Drs Jones and Wright noted that some staple foods in Asian-American diets can elevate CVD risk. For example, rice and noodles are high in sugar, soy and fish sauces are high in sodium, and pork belly, lard, and intestine meats are high in fat. Understanding the patient’s diet is the key to providing culturally tailored lifestyle counseling to mitigate CVD risk in Asian American patients.

Asian American patients may be missing enzymes that help process CVD medications; as a result, clinicians should start at a low dose and titrate. Clinicians should consider aspirin only in circumstances where the benefits outweigh risks, and initiate statins if the patient’s atherosclerotic CVD risk is greater than 7.5% or if their low-density lipoprotein (LDL) level is greater than 190 mg/dL.

Managing Hepatitis B and C Infections in Asian American Patients

Children born to mothers who are positive for hepatitis B should be screened for infection. Patients with hepatitis B or C infection should receive education about how to prevent further liver damage and be advised to avoid drinking alcohol or taking any new medications or over-the-counter products without talking to their provider first.

People born outside the United States are disproportionately more likely to develop hepatitis B; 69% of Americans with a chronic hepatitis B infection were born outside the US. Often because of perinatal infections in endemic countries, Asian Americans account for over 50% of chronic hepatitis B cases in the US.

The Advisory Committee on Immunization Practices (ACIP) recommends that all people aged 18 years or younger receive a hepatitis B vaccine.

Patients aged 18 years or older, pregnant women, or anyone with risk factors, including a history of sexually transmitted infections or multiple sexual partners, current or former incarceration, a current or prior hepatitis C diagnosis or cohabitation with someone positive for hepatitis B, dialysis, HIV, or a history of injectable drug use, should receive triple panel screening (hepatitis B surface antigen, hepatitis B surface antibody, and total hepatitis B core antibody).

Chronic hepatitis B infection is linked to increased cancer risk; people with chronic hepatitis B are more likely to develop liver cancer or cirrhosis and are between 70% and 85% more likely to die prematurely than the general population.

Increasing Cancer Screenings for Asian American Patients

Cancer is the leading cause of death for Chinese, Filipino, Korean, and Vietnamese Americans, and evidence indicates that Asian Americans receive fewer screenings than other racial or ethnic groups in the US. Shame is a factor in the low screening rate, Drs Jones and Wright explained.

“Some Asian women are ashamed to have vaginal exams and pap smears, so they don’t get their routine cervical cancer screening, which leads to them having cervical cancer at a much higher rate.” Dr Jones said.

The most commonly diagnosed cancer among Asian American women is breast cancer; 30% or more of all breast cancer diagnoses in the US are among Chinese, Filipino, Korean, and Vietnamese patients. For Asian American men, prostate cancer is the most common cancer diagnosis.

Korean Americans are significantly more likely to develop gastric cancer than the general population. Therefore, Drs Jones and Wright recommend that Korean Americans receive Helicobacter pylori screening, as this infection is an additional risk factor for developing stomach cancer.

Understanding how genetics influences patients’ risk for developing certain diseases can optimize health outcomes for more than just cancer. For example, people of South Asian descent are more likely to inherit thalassemia than members of the general population. There is also a relatively high prevalence of glucose-6-phosphate dehydrogenase (G6PD) deficiency among people of Asian, African, and Mediterranean descent compared with the general population.

Catching Tuberculosis Early in Patients Born Outside the US

While rare within the US, tuberculosis (TB) disproportionately affects people born outside the country. Four Asian countries – the Philippines, India, Vietnam, and China – are the top 4 of the 5 most common countries of birth among non-US-born people with TB.

Symptoms of TB include a cough longer than 3 weeks, fatigue, fever, chills, night sweats, and weight loss.

“The problem is that because we don’t have that many TB cases in the United States, some providers may have never seen a TB case, and the diagnosis can be missed. ” Dr Wright said.

Providers can diagnose TB via a tuberculin skin test (TST) or interferon-gamma release assay (IGRA). If the TST or IGRA is positive, providers should order a chest x-ray. If the patient presents with symptoms of TB, a positive TST or IGRA, and an abnormal chest x-ray, collection of 3 sputum samples for acid-fast bacilli (AFB) smear and culture is warranted.

Offering Mental Health Services in Multiple Languages

Mental health issues are often heavily stigmatized in Asian cultures. As a result, Asian Americans are less likely to report having mental health concerns, to receive counseling, and to have positive interactions with their mental health providers.

Language barriers further complicate the issue, Drs Jones and Wright explained.

“We don’t have enough mental health providers for each country where patients come from, so that they can fully discuss [what is bothering them],” Dr Wright said. “When they go to a nonnative-speaking provider, the provider may not fully understand about their culture and what they had to go through.”

When Asian Americans are unable to see a provider who speaks the same language as them, some phrases get lost in translation. Having an interpreter present can close some of these gaps, but the presence of a third party may create new issues in mental health settings, such as trust issues and feeling uncomfortable sharing their personal concerns.

“Not all translators are properly trained medical translators,” Dr Wright explained. “I have listened to conversations with online translators or interpreters, and thought, ‘Oh no, that’s not correct. That’s not what the patient is saying,” Dr Jones added.

Providing culturally competent mental health care starts with helping patients feel seen and heard so that they feel comfortable speaking up about mental health concerns, Drs Jones and Wright noted. To mitigate language and cultural barriers, clinicians can refer patients to bilingual mental health professionals who can understand and respect the patient’s unique cultural values. Providing individualized care requires recognizing that each Asian American patient has unique needs. Reducing healthcare disparities and promoting equity can be achieved by understanding each person’s cultural background and ethnicity, which leads to better, more effective care.