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

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.

Personal and social factors that influence physical activity levels in community-dwelling stroke survivors: A systematic review of qualitative literature

“…Research exploring beliefs within culturally diverse stroke populations has shown how this can create significantly varied perceptions and beliefs surrounding health and physical activity behaviours. 46 Further research is therefore needed to determine how much physical activity is completed in the form of social/community participation, and to understand the role that culture plays in physical activity levels in this population.…”

Correlation Between Family Functioning and Health Beliefs in Patients with Stroke in Beijing, China

“…On the other hand, perhaps because most Chinese people are willing to believe in fatalism, many patients said that life and death were fated, so they could instead calmly deal with and follow the treatment, but at the same time, this concept made it easy to make patients let their guard down. Research by Chang et al 33 confirmed that the perception of stroke susceptibility and severity varied among ethnic groups; therefore, cultural factors may also be responsible for different findings in domestic and foreign studies. In addition, the perception impairment score was the lowest score in this study, but this dimension was scored in reverse.…”

The Adherence to Healthy Lifestyle Among Arab Patients With Cardiovascular Disease: Mixed-Method Review

“…The findings of this review showed that the adherence to exercise among Arab patients with CVD is lower than other ethnic populations. In a mixed-method study conducted in the United States, the adherence rate to exercise participation among Arab patients with hypertension ranged between 42.2% compared with White, Black, Vietnamese, and Latino (59%, 43%, 62%, 53%, respectively; Chang et al, 2018). There is strong evidence that socioeconomic predictors such as wealth, higher level of education, and higher annual income, had more tendency to practice regular exercise (Al-Ali & Haddad, 2004;Al-Hassan & Wierenga, 2000).…”