Abstract
Objective: Despite high stroke risk, few Korean-American stroke prevention interventions have been done. We examined conceptions of stroke, including knowledge of risk factors (RFs), symptoms (Sx), prevention, cultural beliefs and perceived consequences, in elderly Korean-Americans. Results were to inform the design of effective and culturally relevant interventions for Korean-American seniors. Methods: Twenty-nine senior Korean-Americans were recruited from 3 locations in southern California: a Korean-American megachurch, and a private and a non-profit adult day health care centers for elderly Korean-Americans. Subjects completed a questionnaire on stroke RFs and Sx, health information sources, health care barriers, personal medical history, comfort with English, and year of immigration. In 3 moderator-facilitated focus groups (FGs), subjects discussed: 1) knowledge of stroke Sxs and RFs, and what to do when stroke occurs; 2) cultural attitudes and perceptions about stroke; 3) personal anecdotes about stroke; 4) preferred methods of education intervention. Discussion audiotapes were transcribed, translated from Korean to English, and validated by 2 bilingual researchers. English transcripts were coded by themes and subthemes independently by 3 raters, who after discussion, came to consensus. An 8-member Community Advisory Panel guided development of discussion guide questions and translations, and collaborated in interpretation. Results: Mean age of subjects was 79.7 years, 62% were female. Mean years in U.S. was 23.9; 24% had less than 8 th grade education. 62% had history of hypertension; 59% had high cholesterol. 86% reported hypertension as a stroke RF, and slurred speech was most commonly identified as a stroke Sx (76%). Television (66%) and physician (59%) were the most common health information sources. 24% had difficulty accessing health care in the past year, with 62% citing discomfort with English language as the hindrance to access. In FGs, RFs emphasized were hypertension and family history, and the most common Sx discussed was being “knocked out.” A common stroke prevention theme was the balance of medication and wellness (exercise/diet). Cultural perceptions of stroke included “destiny,” and beliefs about the efficacy of blood-letting, acupuncture, and Oriental herbs. Attitudes towards stroke included fear and worry: though some viewed death as “fate,” others felt need for education. For stroke prevention, most preferred visual-aid presentations by Korean-speaking medical professionals in a locale familiar to senior Korean-Americans. Conclusions: Elderly Korean-Americans have substantial risk for stroke, but possess both language and belief barriers that may interfere with stroke prevention and response. A stroke education curriculum tailored for elderly Korean-Americans must address these culturally specific beliefs to be effective.
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