Characterizing Beliefs about Stroke and Walking for Exercise among Seniors from Four Racial/Ethnic Minority Communities

• Published in: Journal of cross-cultural gerontology Vol. 33; no. 4; pp. 387 - 410
• Main Authors: Chang, Emiley, Choi, Sarah, Kwon, Ivy, Araiza, Daniel, Moore, Mignon, Trejo, Laura, Sarkisian, Catherine
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.12.2018; Springer Nature B.V
• Subjects: African Americans; African cultural groups; Aged; Aged, 80 and over; Aging; Anthropology; Asian - psychology; Asian Americans; Asian cultural groups; Attention; Barriers; Biomedicine; Black or African American - psychology; Blood pressure; Brain; California - epidemiology; China - ethnology; Chronic illnesses; Chronic pain; Cultural differences; Cultural groups; Disability; Drugs; Emotions; Ethnic groups; Ethnicity; Ethnicity - psychology; Ethnicity - statistics & numerical data; Exercise; Female; Focus Groups; Geriatrics/Gerontology; Health behavior; Health belief model; Health beliefs; Health Knowledge, Attitudes, Practice - ethnology; Health status; Health Status Disparities; Hispanic or Latino - psychology; Humans; Hypertension; Intervention; Language attitudes; Male; Medical conditions; Medicine; Middle Aged; Minority & ethnic groups; Mobility; Motivation; Older people; Original Article; Pain; Paralysis; Participation; Pathophysiology; Philosophy of Medicine; Physical activity; Physical disabilities; Physical fitness; Qualitative Research; Recurrent; Republic of Korea - ethnology; Risk factors; Sedentary Behavior - ethnology; Social Sciences; Stroke; Stroke - ethnology; Stroke - physiopathology; Stroke - prevention & control; Theory of Medicine/Bioethics; Walking; China; Republic of Korea; California; Qualitative research; Racial/ethnic health disparities; Stroke; Cultural tailoring; Health belief model
• ISSN: 0169-3816; 1573-0719; 1573-0719
• DOI: 10.1007/s10823-018-9356-6

We described and compared seniors’ stroke-related health beliefs among four racial/ethnic communities to inform a culturally-tailored stroke prevention walking intervention. Specific attention was paid to how seniors combined pathophysiology-based biomedical beliefs with non-biomedical beliefs. We conducted twelve language-concordant, structured focus groups with African American, Chinese American, Korean American, and Latino seniors aged 60 years and older with a history of hypertension ( n  = 132) to assess stroke-related health beliefs. Participants were asked their beliefs about stroke mechanism and prevention strategies in addition to questions corresponding to four constructs from the Health Belief Model: perceived susceptibility, perceived severity, and benefits and barriers to walking for exercise. Using thematic analysis, we iteratively reviewed and coded focus group transcripts to identify recurrent themes within and between racial/ethnic groups. Participants across all four racial/ethnic groups believed that blockages in brain arteries caused strokes. Factors believed to increase susceptibility to stroke were often similar to biomedical risk factors across racial/ethnic groups, but participants also endorsed non-biomedical factors such as strong emotions. The majority of participants perceived stroke as a serious condition requiring urgent medical attention, fearing paralysis or death, but few mentioned severe disability as a stroke consequence. Participants largely believed stroke to be preventable through physical activity, dietary changes, and medication adherence. Perceived benefits of walking for exercise included improved physical health, decreased bodily pain, and ease of participation. Perceived barriers to walking included limited mobility due to chronic medical conditions, increased bodily pain, and low motivation. While seniors’ stroke-related health beliefs were often similar to biomedical beliefs across racial/ethnic groups, we also identified several non-biomedical beliefs that were shared across groups. These non-biomedical beliefs regarding perceived stroke susceptibility and severity may warrant further discussion in stroke education interventions. Patterns in non-biomedical beliefs that vary between groups may reflect cultural differences. Stroke education could potentially increase cultural relevancy and impact by addressing such differences in health beliefs as well as perceived benefits and barriers to walking for exercise that vary between different racial/ethnic groups.