We explored cultural beliefs around cardiovascular health, and identified the design, content, and implementation features of a novel, culturally relevant text-messaging intervention for Korean-American (KA) and Chinese-American (CA) seniors.

Cardiovascular disease and stroke are leading causes of death in Asian-Americans. Cultural and linguistic barriers may prevent usual-care methods of health education. Free messaging apps are highly used by Asian-Americans, a potentially innovative method of health promotion.   

Using community-based participatory research methods, we partnered with two Chicago community agencies, convening a Community Advisory Board made up of CA and KA individuals who guided project. Using a culturally tailored focus group discussion guide (Health Belief Model), we investigated cultural beliefs of stroke cardiovascular disease in focus groups (FGs) held in community locations. Surveys, including questions on text-messaging, were administered. FGs analyzed via constant comparative method.

A total of 77 seniors participated (44 KA, 33 CA) in 6 FGs. Mean age KA 75.5 years, CA 68.5 years; 75% female KA,72%  female CA. Both groups preferred to speak in native language with PCP >90%; most common healthcare barrier was language. Over half (57% in KA, 81% CA) frequently used text-messaging apps (WeChat in CA, KakaoTalk in KA). CA FG themes included fatalism, and the notion of discipline and willpower in maintaining health; other cultural health ideas included “wild wind,” Chinese herbs, and religion. KA FG themes included personal characteristics and mood/personality as contributing to health, and emphasized diet and nutrition. Both cohorts expressed positive cultural accessibility to text-messaging, preferring gentle but firm messaging, text frequency of 1-7 per week, and inclusion of other mediums (video).

Culturally relevant, community-partnered interventions are necessary in the Asian-American population, as unique beliefs and doctrines may contribute to their ideas of health. Future health interventions must incorporate cultural tailoring to encourage sustainability and acceptability.