Mail Education Is as Effective as In‐Class Education in Hypertensive Korean Patients

Abstract

Many Korean American persons have hypertension, but competing life priorities often prevent them from attending health-promotion educational activities. Using principles of community-based participatory research, the authors conducted a prospective clinical trial to determine the effectiveness of a mailed vs an in-class culturally tailored education intervention. A total of 380 hypertensive Korean American persons from the Baltimore/Washington area were assigned to a more intense inclass education group or a less intensive mail education group. Evaluation of postintervention blood pressure (BP) outcomes revealed that significant reductions in systolic BP (13.3 mm Hg and 16.1 mm Hg, respectively) and diastolic BP (9.5 mm Hg and 10.9 mm Hg) and increases in BP control rates (42.3% and 54.3%) were achieved in both groups. No significant differences in BP outcomes between groups, however, were found. In conclusion, education by mail was an effective strategy for improving BP control and may be a viable approach for other immigrant groups if the education materials address their cultural needs.Managing chronic illnesses such as high blood pressure (BP) is a difficult task for many Americans, 1, 2 but it is even more challenging for new immigrants. Korean Americans, one of the most rapidly growing ethnic minority populations in the United States, have a high prevalence of high BP and its complications.3 Studies of BP in immigrant populations indicate that, in general, the prevalence of high BP increases when a group of immigrants migrates to a more developed country4 because the stress related to acculturation and changes in diet and lifestyle may adversely affect BP levels. [5][6][7][8] Previous reports have indicated that despite the high prevalence of high BP among Korean American persons, individual, cultural, and systemic barriers stand in the way of adequate BP control in this population.9 , 10 Korean American persons experience not only uncontrolled high BP and its complications but also social isolation and a loss of self-confidence. 11 To address this health issue in Korean Americans, a community-based and culturally tailored behavioral intervention program, the Self-Help Intervention Program for High Blood Pressure Care (SHIP-HBP), has been constructed and is currently being implemented. The SHIP-HBP includes a comprehensive intervention trial that combines psychobehavioral education with self-monitoring of BP and bilingual nurse telephone counseling. Our primary goal in designing NIH Public AccessAuthor Manuscript J Clin Hypertens (Greenwich). Author manuscript; available in PMC 2010 July 1. While varying degrees of efficacy have been reported for structured educational interventions, 13-16 the harsh reality is that competing life priorities and limited resources often prevent firstgeneration immigrants from attending health-promotion classes, such as BP management classes. For example, for many middle-aged Korean American persons, time constraints are one of the critical barriers to seeking medica...

Culturally tailored interventions of chronic disease targeting Korean Americans: a systematic review

“…Several interventions were the subject of multiple articles, and they were reviewed together. For example, Han et al (2010) and Kim et al (2008, 2011) reported on the same Self-Help Intervention Program for High Blood Pressure (SHIP-HBP). Another study by Kim et al (2006) reported on SHIP-HBP, but it was a quasi-experimental pilot study of SHIP-DM involving different participants, so was considered separately.…”

“…Of these, several also were guided by other models, for example, HBM plus the Theory of Planned Behavior (TPB) guided one study to promote cancer screening (Maxwell et al 2008), and HBM and the Social Cognitive Theory (SCT) guided two studies to promote cancer screening (Fang et al 2007; Ma et al 2009). The Learned Resourcefulness Model guided two interventions in the area of chronic disease management (Han et al 2010; Kim et al 2006, 2008, 2011). Stress Theory in combination with SCT and Family Systems Theory directed the intervention related to chronic mental illness (Shin 2004; Shin and Lukens 2002).…”

Implementation and success of nurse telephone counseling in linguistically isolated Korean American patients with high blood pressure

“…After a 6-week education and a 6-week test period for home BP monitoring, telephone counseling was begun and continued for 12 months. The changes in BP outcomes have been reported elsewhere [28]. …”

“…The Self-Help Intervention Program for HBP Care (SHIP-HBP) was developed and evaluated as a means of addressing the lack of adequate HBP care and control among KAs [27,28]. The SHIP-HBP consisted of psycho-behavioral education, together with self-monitoring of BP, and telephone counseling.…”

Translation and Validation of the Dietary Approaches to Stop Hypertension for Koreans Intervention

“…Despite overwhelming evidence for the effectiveness of pharmacological interventions in reducing BP, many people with HBP intentionally delay or avoid pharmacological treatment for their condition. 21,50,51 Certain cultural groups such as KAs prefer dietary changes or supplements to pharmacological therapy for the treatment of hypertension. 52,53 Demonstrating the effectiveness of such nonpharmacological approaches is an important area of intervention research.…”