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

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Abstract

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.

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Acknowledgements

The authors would like to acknowledge our community partners, including the twenty Community Action Board members of L.A. CAPRA (http://lacapra.med.ucla.edu/who.htm). The authors also thank Sina Ma of Chinatown Service Center, Carol Lee Thorpe and Barbara Linski of St. Barnabas Senior Services, and Phyllis Willis of Watts Labor Community Action Committee for their enthusiasm, support, and commitment to community-academic partnered research.

Funding

This study was supported by the National Institute of Neurological Disorders and Stroke (grant number 5U54NS081764–02); Office of Research on Women’s Health (grant number 3U54NS081764–02S2); and the National Institute on Aging (grant number 1RC4AG038182), which funded the L.A. CAPRA Center. Additional sources of support include the National Institute on Aging UCLA Older Americans Independence Center (grant number P30 AG028748); the National Institute on Aging Resource Centers for Minority Aging Research IV/Center for Health Improvement of Minority Elderly III (grant number 2P30AG081684–11); the National Institutes of Health Midcareer Award in Patient-Oriented Community-Academic Partnered Aging Research (grant number 1K24AG047899–01, to Dr. Sarkisian); the UCLA Hartford Center of Excellence (sponsored by the American Federation for Aging Research and the John A. Hartford Foundation); the UCLA Faculty Training Program in Geriatric Medicine, Psychiatry and Dentistry (sponsored by the Bureau of Health Professions); and the National Institutes of Health Ruth L. Kirschstein National Research Service Award (NRSA).

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Authors and Affiliations

  1. Department of Medicine, General Internal Medicine, Harbor-UCLA Medical Center, 1000 W. Carson Street, Torrance, CA, 90502, USA

    Emiley Chang

  2. David Geffen School of Medicine, University of California, Los Angeles, 885 Tiverton Drive, Los Angeles, CA, 90095, USA

    Emiley Chang

  3. School of Nursing, University of California, Los Angeles, 700 Tiverton Avenue, Los Angeles, CA, 90095, USA

    Sarah Choi

  4. Clinical Solutions Associate, Science 37, 12121 Bluff Creek Drive, Suite 100, Los Angeles, CA, 90094, USA

    Ivy Kwon

  5. Graduate School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA

    Daniel Araiza

  6. Department of Sociology, Barnard College, Columbia University, 3009 Broadway, New York, NY, 10027, USA

    Mignon Moore

  7. City of Los Angeles Department of Aging, 221 N. Figueroa Street, Suite 500, Los Angeles, CA, 90012, USA

    Laura Trejo

  8. Department of Medicine, Division of Geriatrics, University of California, Los Angeles, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA, 90095, USA

    Catherine Sarkisian

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  1. Emiley Chang
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Correspondence to Emiley Chang.

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Chang, E., Choi, S., Kwon, I. et al. Characterizing Beliefs about Stroke and Walking for Exercise among Seniors from Four Racial/Ethnic Minority Communities. J Cross Cult Gerontol 33, 387–410 (2018). https://doi.org/10.1007/s10823-018-9356-6

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