Interventions for Cardiovascular Disease Risk Reduction in Korean Americans: A Systematic Review.

This systematic review was to identify and synthesize literature that described the cultural appropriateness and effectiveness of interventions aimed at cardiovascular risk reduction in Korean Americans. We searched multiple electronic databases for studies published between January 2000 and August 2017 and identified 14 eligible research reports. All reviewed studies targeted first-generation Korean American adults. Most of the reviewed studies incorporated components of surface structure, and leveraged deep structure in those interventions. Significant changes in cardiovascular health outcomes were reported in most of the reviewed studies; however, the role of cultural factors in the outcomes was rarely evaluated, and few reported long-term effects. Future research needs to consider long-term effects. Deploying cultural factors and evaluating their contributions to the target outcomes will enhance the research on cardiovascular health disparities.

Psychosocial Factors and Dietary Practices in Korean Americans.

This study was to identify the role of demographics and social support from family and friends in predicting self-efficacy for a healthy diet and healthy dietary practices. A descriptive, cross-sectional study was conducted with a sample of 112 Korean American adults in the southwestern United States. Most were college educated (85.3%), with mean age of 54.0 (± 10.6), and women (66.4%). The findings indicate that gender and education played a moderating role between family support and self-efficacy for a healthy diet, whereas age and education were moderators between support from family and friends and healthy dietary practices. Diet interventions tailored to demographic subgroups may increase self-efficacy, promote healthy dietary practices, and ultimately contribute to a reduction in the rates of critical health conditions and health costs in the community.

Physical activity, benefits, and barriers across the aging continuum.

BACKGROUND: A growing body of evidence indicates the importance of physical activity during midlife period linked to the likelihood of healthy aging, while the likelihood of an individual engaging in physical activity depends largely on their perceived benefits and barriers to being physically active. AIM: This study was to examine physical activity levels of midlife Korean American adults and their perceived benefits and barriers to physical activity compared with young and older adults. METHODS: We conducted a secondary analysis of data collected for a larger descriptive, cross-sectional study that was conducted with a sample of 517 Korean American adults in a Midwestern city. Data were collected using a survey questionnaire. RESULTS: A little more than half of the sample were women (57.1%), with a mean age of 41.6 (±â€¯13.4). The study sample met the current guidelines for physical activity far less than the general U.S. population (30.4% -34.6 vs. 51.7%). Less midlife adults met the guidelines for moderate-intensity physical activity than older adults (34.2% vs. 57.4%), while less midlife adults met the guidelines for vigorous-intensity physical activity than young adults (24.8% vs. 40.6%). Midlife adults perceived fewer benefits than did young and older adults. CONCLUSION: The findings indicate that midlife adults are less likely to engage in physical activity and probably more at risk for unhealthy ageing than young and older adults. Understanding benefits and barriers of target population is the first step in developing culturally and age-appropriate intervention to promote physical activity.

Trustworthiness, Readability, and Suitability of Web-Based Information for Stroke Prevention and Self-Management for Korean Americans: Critical Evaluation.

BACKGROUND: Websites are common sources of health information to stroke survivors and caregivers for continual management of stroke and its long-term sequelae. The presence of risk factors and mortality rates related to stroke are high in Korean Americans. A vast majority of this group are active Web users and rely on the Web-based information due to lack of insurance and, thus, limited access to long-term stroke care. Thus, it is critical to evaluate existing stroke websites for their trustworthiness, readability, and suitability. OBJECTIVE: The objective of our study was to provide a systematic evaluation of stroke-related websites regarding (1) trustworthiness, (2) readability, and (3) suitability for stroke prevention and self-management for Korean Americans. METHODS: We selected a total of 156 websites using search terms "stroke," "CVA," "중풍 (jungpung)," and "뇌졸증 (noejoljung)" on Google and Yahoo. After eliminating duplicates and irrelevant websites (n=116), we evaluated a total of 42 websites (15 in English and 27 in Korean) using the National Library of Medicine's health website's evaluation tool for trustworthiness; Simple Measure of Gobbledygook for readability; and Suitability Assessment of Materials for suitability. All three instruments used the 3-point Likert scale: superior (=2), adequate (=1), or not suitable (=0). RESULTS: Of the 42 websites evaluated, we rated 62% (26/42) websites as "adequate" or above for trustworthiness. The information on 48% (20/42) websites had not been updated for more than a year, which indicates poor currency; 33% (14/42) websites failed to provide the publisher and contact information, which yields poor authority; 50% (21/42) websites did not cite sources of health information, which indicates lack of accuracy. Only 2 websites met the recommended readability (5th grade or lower reading level). The suitability was also suboptimal; only 1 website was rated as "superior"; 60% (25/42) websites were "adequate," and 38% (16/42) were "not suitable." Most websites were limited in graphical directions, interactive motivations for desired healthy behaviors, and multiple language translations. CONCLUSIONS: The existing stroke-related websites in either English or Korean are trustworthy and suitable, yet precise citation of evidence-based information will improve trustworthiness. The contents requiring high reading level may set a barrier to the utilization of Web-based health information for Korean Americans with a lower level of education. In addition, supplementing graphical examples, interaction features, and culturally relevant information in multiple languages are the areas for improvement in suitability. The improved features can reduce the reading burden of stroke patients or caregivers and build their confidence when applying the information for stroke management in daily living. These strategies are especially crucial to Korean Americans, who inevitably seek Web-based information to fill the gap between their demand and access to health care for a long-term self-management after a stroke.

Acculturation, Cultural Values, and Breastfeeding in Overweight or Obese, Low-Income, Hispanic Women at 1 Month Postpartum.

BACKGROUND: Most Hispanic infants are fed formula during the first 6 weeks, and although 80% of Hispanic women initiate breastfeeding, rates of exclusive breastfeeding are much lower. Research aim: The purpose was to examine the influence of acculturation and cultural values on the breastfeeding practices of pregnant women of Mexican descent participating in the Special Supplemental Nutrition Program for Women, Infants, and Children who were enrolled in a prospective randomized clinical trial that aimed to reduce child obesity. The data were abstracted from a larger randomized clinical trial focused on prevention of child obesity. METHODS: The sample consisted of 150 women of Mexican origin who were enrolled at the time of these analyses from the randomized clinical trial and had a prepregnancy body mass index of ≥ 25 and spoke English and/or Spanish. All breastfeeding data for this report came from data collection at 1 month postpartum. RESULTS: A higher score on the Anglo orientation scale of the Acculturation Rating Scale for Mexican Americans was associated with less breastfeeding at 1 month postpartum and less exclusive breastfeeding. CONCLUSION: Acculturation plays a role in breastfeeding practice. Exploring acculturation associated with breastfeeding can guide us to design culturally relevant interventions to promote breastfeeding exclusivity among immigrant mothers.

Cultural Factors relevant to Korean Americans in Health Research: A Systematic Review.

To eliminate health disparities in the United States, identifying cultural contexts salient to the target populations in an intervention study is critical; however, little research has been conducted on the identification of cultural contexts among Korean Americans who have significant risk factors for chronic diseases. This systematic review identifies critical cultural contexts central to the literature discussed in health research on Korean Americans. We examined 14 research reports of 801 potentially eligible articles published between 2000 and 2016 and analyzed their contribution to cultural contexts among Korean Americans based on the PEN-3 model. This review highlights how cultural contexts impact health and health behaviors of Korean Americans, and may contribute to health disparities in the United States. The key cultural contexts highlighted in this review include social support/social network, family, gender role expectations, and a holistic view of health and illness. These cultural contexts should be incorporated in designing culturally relevant, effective, and sustainable health interventions for Korean Americans, which will contribute to eliminating health disparities for this ethnic group who experience great obstacles to healthcare access and healthy behaviors.

Cardiovascular Disease in Korean Americans: A Systematic Review.

BACKGROUND: Despite Korean Americans being one of the fastest growing immigrant groups in the United States, little is known about their cardiovascular health or cardiovascular disease risk factors. PURPOSE: The purpose of this report is to describe the prevalence of cardiovascular disease risks and their contributing factors in Korean Americans and recommend future directions for the development of cardiovascular disease prevention or management research to meet the unique needs of this ethnic group. METHODS: We conducted a systematic review using databases of PubMed, CINAHL, PsycINFO, Web of Science, and the Cochrane Database of Systematic Reviews and identified 27 studies that reported the prevalence of cardiovascular disease or its risk factors in Korean Americans, published in English between 2000 and 2016. RESULTS: We found high rates of unhealthy behaviors (eg, consumption of a high-sodium diet, physical inactivity, smoking) and risk factors (eg, hypertension, diabetes) for cardiovascular disease. Moreover, they were less likely to receive counseling about their diseases from healthcare providers and modify their lifestyle (eg, reduce their diet sodium intake, control their weight) to manage their diseases than were other ethnic populations. Individual-, interpersonal-, community-, and societal-level influences contributed to the high prevalence of cardiovascular risk factors. CONCLUSIONS: Data on subgroups of Asian Americans indicate that Korean Americans have significant lifestyle-related cardiovascular disease risks, which could be a critical agenda for researchers and clinicians to better understand cardiovascular health disparities in the United States.

Acculturative stress in Korean Americans.

BACKGROUND: Acculturative stress is known to contribute to chronic diseases among many immigrants and yet this association in Korean Americans remains unclear. AIM: The study purpose was to examine the level of acculturative stress in Korean Americans and to determine if correlations existed with personal and physiological factors. METHODS: An exploratory, cross-sectional, descriptive study was conducted in a sample of 107 Korean American adults. Data on acculturative stress and personal factors were collected using a survey questionnaire in addition to a direct measure of physiological factors (i.e., body mass index and blood pressure). RESULTS: All 107 participants were first-generation Koreans. Most participants were women (66.4%), with a mean age of 53.9±10.7, married (88.8%), and with a college education (84.2%). Acculturative stress was associated with a number of personal factors (i.e., arrival age, years of U.S education, years of U.S. residency, English proficiency), and the personal factors of gender, age, employment status, and years of U.S. residency were associated with the physiological factors. No statistically significant associations were found between acculturative stress and physiological factors. CONCLUSIONS: The mean acculturative stress score in this study was higher than findings from prior studies of Korean immigrants in the United States or Canada, with the rates of obesity and hypertension higher than prior reports of Korean Americans or Koreans residing in Korea. Future study is necessary with a larger sample from a variety of different geographic areas of the United States to examine further the impact of acculturative stress on physiological factors during the process of acculturation.

Unidimensional and Bidimensional Approaches to Measuring Acculturation.

BACKGROUND AND PURPOSE: Researchers easily overlook the complexity of acculturation measurement in research. This study is to elaborate the shortcomings of unidimensional approaches to conceptualizing acculturation and highlight the importance of using bidimensional approaches in health research. METHODS: We conducted a secondary data analysis on acculturation measures and eating habits obtained from 261 Korean American adults in a Midwestern city. RESULTS: Bidimensional approaches better conceptualized acculturation and explained more of the variance in eating habits than did unidimensional approaches. CONCLUSION: Bidimensional acculturation measures combined with appropriate analytical methods, such as a cluster analysis, are recommended in health research because they provide a more comprehensive understanding of acculturation and its association with health behaviors than do other methods.

Development and Validation of the Narrative Quality Assessment Tool.

BACKGROUND AND PURPOSE: The use of storytelling in health promotion has grown over the past 2 decades, showing promise for moving people to initiate healthy behavior change. Given the increasingly prevalent role of storytelling in health promotion research and the need to more clearly identify what storytelling elements and mediators may better predict behavior change, there is a need to develop measures to specifically assess these factors in a cultural community context. The purpose of this study is to develop and preliminarily validate a narrative quality assessment tool for measuring elements of storytelling that are predicted to affect attitude and behavior change (i.e., narrative characteristics, identification, and transportation) within a cultural community setting using a culture-centric model. METHODS: Reliability and validity of these scales were assessed with repeated administrations among 74 Latino men and women with a mean age of 39.6 years (SD = 11.47 years). RESULTS: The confirmatory factor analysis in addition to internal consistency tests revealed preliminary evidence for reliability and validity of the narrative characteristics, identification, and transportation scales. Cronbach's alpha ranged from .92 to .94. Items revealed adequate factor loadings (.85-.98) and good model fit. CONCLUSION: The new scales provide the first step in moving the assessment of narrative quality into a culturally relevant context for evaluation of story use in health promotion. The results present valuable information for nurse researchers to guide the development and testing of culturally grounded storytelling interventions' potential to predict attitude and behavior change for patients.

Facilitators of and barriers to emergency medical service use by acute ischemic stroke patients: A retrospective survey.

OBJECTIVE: The objective of the study was to identify facilitators and barriers to emergency medical service use among acute ischemic stroke patients in Korea. METHODS: This paper presents a secondary analysis of a retrospective survey that collected data from questionnaires and medical records. Among 233 acute ischemic stroke patients enrolled in a large-scale study, 160 patients who had arrived at a hospital within 72 h after symptom onset were included in the data analysis. RESULTS: Users of emergency medical services needed a shorter time than non-users to arrive at hospital (140 min vs. 625 min., p = 0.001) and were more likely to arrive at hospital within 3 h of symptom onset (51.9% vs. 31.5%, p = 0.013). For those who first contacted emergency medical service, the facilitators of emergency medical service use were the presence of hemiparesis (p = 0.003), bilateral paralysis (p = 0.040), and loss of balance (p = 0.021). The predominant barrier was the failure to recognize the urgency of symptoms (p = 0.006). CONCLUSIONS: The use of emergency medical services reduced prehospital delay and increased the likelihood of patient arrival at hospital within 3 h. Given that experiencing typical stroke symptoms was a facilitator of emergency medical service use yet failure to recognize the urgency of symptoms was a barrier, public awareness should be raised as regards stroke symptoms and the benefits of using emergency medical services.

Association of Discrimination and Stress With Cardiometabolic Risk Factors in Ethnic Minority Women.

Psychological stressors can contribute to adverse health outcomes and lead to health disparities. To examine associations among psychological stressors, coping, blood pressure, body mass index, and body fat in ethnic minority women, we conducted a secondary analysis using data from 178 African American and Hispanic/Latina women who completed measures of perceived racial discrimination and stress, coping, blood pressure, and body composition. The mean age of participants was 45.3 (±9.3 years), and most were obese (74.2%) and had prehypertensive systolic blood pressure (125.7 ± 14.6 mmHg). Hierarchical multiple regression models indicated a significant negative relationship between racial discrimination and percent body fat, and positive associations between stress and blood pressure. Coping did not moderate the association between racial discrimination and blood pressure or body composition. Health care providers should consider psychological stressors as underlying causes for hypertension and address tailored stress-reduction coping strategies when treating African American and Hispanic/Latina women with hypertension.

Culturally Competent Nurse Educators in Clinical Teaching.

Having culturally competent nurse educators is crucial to preparing future nurses to meet the health needs of a diverse and multicultural United States population. The authors explored the perspectives of 21 clinical nurse educators on a variety of clinical nursing situations related to cultural diversity. They identified five themes that emerged from a content analysis and represented a range of perspectives. The authors recommend three strategies to be integrated into programs that will educate nursing students in providing care to a diverse patient population.

How Did They Grow: An Intervention to Reduce Stunted Growth in Low-Income Mexican-American Children.

Growth stunting is a complex phenomenon related to undernutrition that can contribute to developmental delay, cognitive deficits, and small size and obesity in adulthood. Stunted growth, defined as height for age below the 5th percentile, is primarily caused by chronic malnutrition. In this study, a community-based intervention to reduce undernutrition was tested in a quasi-experimental design with 174 low-income, Mexican-American mothers and children recruited from a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic in a major southwestern city. The intervention was based on the public health nursing practice of collaborating with mothers of young children on appropriate nutrition and parenting, and was tailored by the author and community informants for mothers of children with stunted growth. Data were collected on child height and weight, dietary intake, maternal acculturation, maternal perceived stress as measured by the Perceived Stress Scale (PSS), home environment as measured by the home screening questionnaire (HSQ), and maternal-child interaction as measured by the Nursing Child Assessment Teaching Scale (NCATS). Intervention children had higher growth velocity than the children in the comparison group. These findings were especially prominent for children of women who were older and less acculturated. Results suggest that a nursing intervention delivered in collaboration with WIC can make a significant improvement in growth of low-income children with growth stunting.

Factors Associated With the Hospital Arrival Time in Patients With Ischemic Stroke in Korea.

BACKGROUND: Stroke is a leading cause of death and disability among the Korean population. Ischemic stroke patients tend to delay arrival at the hospital and often miss the "golden" 3-hour window, which is optimal for tissue plasminogen activator treatment. OBJECTIVE: The purposes of this study were to compare demographic, clinical/behavioral, and sociocultural characteristics of ischemic stroke patients who reside in urban and rural areas of Korea and to identify factors contributing to the time taken from symptom onset to hospital arrival. METHODS: A cross-sectional, descriptive study was conducted using a structured survey in a convenience sample of 229 ischemic stroke patients in Korea. RESULTS: Individuals who resided in rural areas were more likely to be female, older, less educated; had lower incomes; contacted adult children at the onset of stroke; and took a longer time to be transported to a hospital than did those who resided in urban areas (P < .05). Patients who visited an emergency room, transferred via an ambulance, contacted emergency medical services, perceived symptoms as serious, had a family history of stroke, or experienced hemiparesis as the primary stroke symptom arrived at the hospital relatively sooner, whereas patients who experienced unclear symptoms took relatively more time to arrive at the hospital following symptom onset (P < .05). CONCLUSIONS: Nationwide efforts are needed to promote public awareness of stroke and to develop strategies to reduce prehospital delay time for ischemic stroke patients, particularly those who reside in rural areas in Korea.

The role of social support and social networks in health information-seeking behavior among Korean Americans: a qualitative study.

INTRODUCTION: This study used social network theory to explore the role of social support and social networks in health information-seeking behavior among Korean American (KA) adults. METHODS: A descriptive qualitative study using a web-based online survey was conducted from January 2013 to April 2013 in the U.S. The survey included open-ended questions about health information-seeking experiences in personal social networks and their importance in KA adults. Themes emerging from a constant comparative analysis of the narrative comments by 129 of the 202 respondents were analyzed. RESULTS: The sample consisted of 129 KA adults, 64.7% female, with a mean age of 33.2 (SD = 7.7). Friends, church members, and family members were the important network connections for KAs to obtain health information. KAs looked for a broad range of health information from social network members, from recommendations and reviews of hospitals/doctors to specific diseases or health conditions. These social networks were regarded as important for KAs because there were no language barriers, social network members had experiences similar to those of other KAs, they felt a sense of belonging with those in their networks, the network connections promoted increased understanding of different health care systems of the U.S. system, and communication with these network connections helped enhance feelings of being physically and mentally healthy. CONCLUSIONS: This study demonstrates the important role that social support and personal social networks perform in the dissemination of health information for a large ethnic population, KAs, who confront distinct cultural challenges when seeking health information in the U.S. Data from this study also illustrate the cultural factors that influence health information acquisition and access to social support for ethnic minorities. This study provides practical insights for professionals in health information services, namely, that social networks can be employed as a channel for disseminating health information to immigrants.

Acculturation and Health of Korean American Adults.

Increasing cultural diversity in the United States and significant health disparities among immigrant populations make acculturation an important concept to measure in health research. The purpose of this cross-sectional, descriptive study was to examine acculturation and health of Korean American adults. A convenience sample of 517 Korean American adults in a Midwestern city completed a survey in either English or Korean. All four groups of Berry's acculturation model were identified using cluster analysis with Lee's Acculturation Scale. Assimilation, integration, and separation were found in the English survey sample, whereas integration, separation, and marginalization were found in the Korean survey sample. Moreover, the findings revealed that acculturation is a bidimensional process, and the unique nature of samples may determine acculturation groups. Physical health and mental health were significantly related to acculturation in the English survey sample. However, there was not a significant relationship between health and acculturation in the Korean survey sample.

The effects of cranberries on preventing urinary tract infections.

Despite considerable controversy about their effects, cranberries in various forms have been used widely for several decades to prevent as well as treat urinary tract infections (UTIs). The purpose of this article is to present a review of research-based information regarding the ability of cranberries to prevent UTIs in adults at risk for UTIs. Current evidence suggests that cranberries decrease bacterial adherence to uroepithelial cells and thus decrease the incidence of UTIs without adverse effects in most individuals. Thus clinicians may safely advise patients that cranberries are helpful in preventing UTIs. Cranberries may be a viable adjunct to antibiotics for patients with repeated UTIs.

Nutritional issues of Korean Americans.

This cross-sectional, descriptive study examined factors influencing healthy eating of Korean Americans in a convenience sample of 517 Korean adults in a Midwestern city. Participants completed a self-administered survey written in either English or Korean as their preferences, which measured health, acculturation, healthy eating benefits, barriers, and self-efficacy as well as healthy eating practice. Descriptive statistics, cluster analysis, and structural equation modeling were used for analysis. Participants reported retaining elements of the traditional Korean diet regardless of acculturation. The worst eating habits were seen in participants who were younger (t = 4.57), currently not married (t = 3.10), less educated (F = 5.03), and acculturated to American society (F = 5.93) at the p < .05. Clinicians should provide culturally sensitive interventions targeting Korean Americans with poor dietary habits by providing population-specific, tailored interventions about the benefits of healthy eating and modeling healthier recipes for traditional Korean dishes.