Mo-Kyung Sin

Using photovoice to understand cardiovascular health awareness in Asian elders.

Photovoice, a qualitative methodology using photography by study participants, is an ideal tool for collecting information on awareness of cardiovascular health from the perspective of persons of different cultural backgrounds and English-speaking abilities who are often subject to health disparities. Participants of Chinese, Vietnamese, and Korean ethnicity were provided disposable cameras to photograph their perceptions of scenes promoting or acting as barriers to cardiovascular health. After the pictures were developed, they returned for a discussion in their native languages to contextualize the stories told in their photographs. Group facilitators spoke the respective native languages and transcribed sessions into English. Twenty-three adults participated (7 to 9 persons per ethnicity), ranging in age from 50 to 88 (mean 71.6) years; 48% were women. The photographs stimulated conversations of knowledge, beliefs, and concerns regarding heart disease and stroke. Issues surrounding food and exercise were most dominant across ethnic groups, focusing on fat and salt intake and the need to remain active. Cultural beliefs and issues of emotional health, including stress and loneliness related to living in a new country, were also depicted. Photovoice provided insight into perceptions of cardiovascular health that is vital for developing health promotion and education interventions in limited–English-speaking communities.

Personal characteristics, health status, physical activity, and quality of life in cardiac rehabilitation participants.

The purpose of this study was to examine the relationships between personal factors, health status, and adherence to physical activity behavior, and quality of life in cardiac rehabilitation participants. The record of 146 subjects, who met inclusion criteria were obtained from the University Cardiac Rehabilitation Database. Change scores in physical activity were used as a proxy for adherence. Participants who were categorized as not working, female gender, and at high-risk health status had lower means and lower improvement scores from repeated measures analysis of variance. This study found that some personal factors and health status are significant factors influencing the participants adherence to physical activity recommendations and quality of life in this cardiac rehabilitation program.

Perceptions of Depression in Korean American Immigrants

Despite its high prevalence, depression is often unrecognized and untreated in minority immigrants. Culture and environment influence perceptions of depression. The purpose of this study was to understand perceptions of depression (knowledge and coping mechanisms) in Korean American immigrants using focus group discussions. A convenience sample (n = 28) was recruited from Korean communities in the Puget Sound region of Washington State. Participants lacked an understanding of depression. Difficulties from immigration-related environmental changes were the main sources of stress. Immigration-related environmental changes resulted in changes in coping resources. Culture-friendly education and coping resources might benefit this minority group.

Personal characteristics predictive of depressive symptoms in Hispanics with heart failure.

Depression is a significant problem in heart failure (HF). The purposes of this study were to assess the prevalence of depressive symptoms in Hispanics with HF and to examine the personal characteristics predicting depressive symptoms at baseline and at 6-months follow-up in a telephone case management intervention. In this secondary data analysis based on 87 subjects, patient characteristics hypothesized to influence depressive symptoms included age, gender, education, living situation, co-morbidity, social support, New York Heart Association (NYHA) class, and acculturation. DSM-IV major depression was present in 39.1% (n = 35) of the participants at baseline and 1.1% (n = 1) at the 6-month follow-up. In regression analysis, factors associated with depressive symptoms at baseline were gender and NYHA class. At 6-month follow-up, acculturation, co-morbidity, and NYHA were significantly related to the presence of depressive symptoms. Depressive symptoms were highly prevalent in Hispanics with HF. Easily identifiable personal characteristics can be useful in designing interventions to reduce depression associated with HF.

Communicating With Pictures: Perceptions of Cardiovascular Health Among Asian Immigrants

CARDIOVASCULAR DISEASE (CVD) is one of the leading causes of morbidity and mortality in the United States, and does not discriminate by ethnicity.1 In fact, the health of many US ethnic minorities, especially immigrants, is known to be poorer than their Caucasian counterparts living at similar socio-economic levels and geographic regions.2–5 Issues related to poverty, heath care access, and quality of care greatly impact rates of disease once immigrants arrive in this country.6,7 Efforts to develop health promotion programs to decrease risk factors for CVD are complex because of language and cultural issues that must be addressed for efforts to succeed. It is important to “see” what a targeted group sees, to understand how they view specific topics if one intends messages to relate to them.

Cardiovascular health perceptions in multigenerational Korean immigrants.

Cardiovascular disease is prevalent in the Korean immigrants. Success of any health interventions depends heavily on our understanding of how health issues are perceived by the recipients. This study describes cardiovascular health perceptions using Photovoice, a qualitative methodology utilizing photography to initiate discussion, in multigenerational Korean immigrants (older adults, teenagers, children). Twenty Korean Americans (7 adults aged ≥50 years, 6 teenagers aged 13 to 19 years, 7 children aged 9 to 12 years) were recruited from the Korean communities in Seattle, Washington. Each subject was given a camera and asked to take 24 pictures of objects, scenes, and environments that represented their perceptions of cardiovascular health and related risk factors. Subjects were asked to pick 2 photos and present their thoughts about them in a tape-recorded group meeting. Key concepts were identified from the discussions. Themes identified promoting cardiovascular health included good diet, exercise, a clean environment, and spirituality. The themes identified as the risk factors for cardiovascular diseases included bad diet, smoking, pollution, and stress. Expression of the risk factors differed by the age group. The shared cultural background also influenced the perception of the risk factors. These observations support the findings that the culture and age-specific interventions may augment intervention effectiveness.

A Qualitative Analysis of Stress and Coping in Korean Immigrant Women in Middle-age and Older-adulthood

This qualitative grounded theory study explored stress-coping mechanisms in 14 Korean immigrant women (age ≥40) in the USA, by analyzing existing focus group data about relevant concepts that had been collected in a parent study. Using content analysis, stressors related primarily to socioenvironmental changes following immigration: language barriers, lack of trusting human relationships, and role changes were identified. Both healthy (activities, church, staying busy) and unhealthy (being alone and keeping negative feelings inside) coping strategies were reported by participants. The findings reveal unique aspects of stress-coping among Korean women who had immigrated after being culturally engrained with Confucian influences.

Characteristics and Outcomes of Patients With Advanced Chronic Systolic Heart Failure Receiving Care at the Veterans Affairs Versus Other Hospitals Insights From the Beta-blocker Evaluation of Survival Trial (BEST)

Background—Characteristics and outcomes of patients with heart failure and reduced ejection fraction receiving care at Veterans Affairs (VA) versus non-VA hospitals have not been previously reported. Methods and Results—In the randomized controlled Beta-blocker Evaluation of Survival Trial (BEST; 1995-1999), of the 2707 (bucindolol=1353; placebo=1354) patients with heart failure and left ventricular ejection fraction ⩽35%, 918 received care at VA hospitals, of which 98% (n=898) were male. Of the 1789 receiving care at non-VA hospitals, 68% (n=1216) were male. Our analyses were restricted to these 2114 male patients. VA patients were older with higher symptom and comorbidity burdens. There was no significant between-group difference in unadjusted primary end point of 2-year all-cause mortality (35% VA versus 32% non-VA; hazard ratio associated with VA hospitals, 1.09; 95% confidence interval, 0.94–1.26), which remained unchanged after adjustment for age and race (hazard ratio, 1.00; 95% confidence interval, 0.86–1.16) or multivariable adjustment, including cardiovascular morbidities (hazard ratio, 0.94; 95% confidence interval, 0.80–1.10). There was no between-group difference in cause-specific mortalities or hospitalizations. Chronic kidney disease, pulmonary edema, left ventricular ejection fraction <20%, and peripheral arterial disease were significant predictors of mortality for both groups. African America race, New York Heart Association class IV symptoms, atrial fibrillation, and right ventricular ejection fraction <20% were associated with higher mortality among non-VA hospital patients only; however, these differences from VA patients were not significant. Conclusions—Patients with heart failure and reduced ejection fraction receiving care at VA hospitals were older and sicker; yet their risk of mortality and hospitalization was similar to younger and healthier patients receiving care at non-VA hospitals. Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000560.

Sociocultural Barriers to Lung Cancer Screening Among Korean Immigrant Men

Lung cancer is a commonly occurring cancer among Korean American men. Korean Americans have lower rates of cancer screening participation than other Asian American sub-groups. However, little is known about factors that influence the cancer screening behavior of Korean immigrants. The purpose of this study was to explore facilitators of and barriers to lung cancer screening (i.e., low dose CT of the chest) among Korean immigrant men, using qualitative individual interviews and focus groups. A convenience sample of 24 Korean men who were immigrants, Washington State residents, able to speak Korean, aged 55–79, and eligible for lung cancer screening (based on current guidelines) were recruited from Korean churches and senior centers. Five focus groups (that included between two and five men) and nine individual interviews were conducted. Content analysis was used to analyze the qualitative data. Facilitators of lung cancer screening included perceptions about positive aspects of the health care system in South Korea, recommendations from others (physicians, family members, and community organizations), existing health problems and respiratory symptoms, interest in health, and the health consequences of aging. Barriers included costs of health care in the US, lack of time, lack of knowledge (about lung cancer and screening), attitudes about prevention, and lack of physician recommendation. This study adds new knowledge to a field where little information is available. It also lays the groundwork for developing culturally relevant lung cancer screening interventions for Korean Americans and the health care providers who serve them.

Characteristics and Outcomes of Patients With Advanced Chronic Systolic Heart Failure Receiving Care at the Veterans Affairs Versus Other HospitalsCLINICAL PERSPECTIVE

Background—Characteristics and outcomes of patients with heart failure and reduced ejection fraction receiving care at Veterans Affairs (VA) versus non-VA hospitals have not been previously reported. Methods and Results—In the randomized controlled Beta-blocker Evaluation of Survival Trial (BEST; 1995-1999), of the 2707 (bucindolol=1353; placebo=1354) patients with heart failure and left ventricular ejection fraction ⩽35%, 918 received care at VA hospitals, of which 98% (n=898) were male. Of the 1789 receiving care at non-VA hospitals, 68% (n=1216) were male. Our analyses were restricted to these 2114 male patients. VA patients were older with higher symptom and comorbidity burdens. There was no significant between-group difference in unadjusted primary end point of 2-year all-cause mortality (35% VA versus 32% non-VA; hazard ratio associated with VA hospitals, 1.09; 95% confidence interval, 0.94–1.26), which remained unchanged after adjustment for age and race (hazard ratio, 1.00; 95% confidence interval, 0.86–1.16) or multivariable adjustment, including cardiovascular morbidities (hazard ratio, 0.94; 95% confidence interval, 0.80–1.10). There was no between-group difference in cause-specific mortalities or hospitalizations. Chronic kidney disease, pulmonary edema, left ventricular ejection fraction <20%, and peripheral arterial disease were significant predictors of mortality for both groups. African America race, New York Heart Association class IV symptoms, atrial fibrillation, and right ventricular ejection fraction <20% were associated with higher mortality among non-VA hospital patients only; however, these differences from VA patients were not significant. Conclusions—Patients with heart failure and reduced ejection fraction receiving care at VA hospitals were older and sicker; yet their risk of mortality and hospitalization was similar to younger and healthier patients receiving care at non-VA hospitals. Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000560.