Development of a Diabetes-Focused Print Health Literacy Scale Using the Rapid Estimate of Adult Literacy in Medicine Model.

BACKGROUND: A diabetes mellitus (DM)-specific health literacy (HL) measure that focuses on both oral and print HL is needed in clinical and research settings. OBJECTIVE: The present study developed a psychometrically sound DM-specific HL instrument that measures oral and print HL. METHODS: We developed the measure in three steps. First, we reviewed clinical guidelines and conducted focus groups with experts to generate items. Next, we conducted a psychometric evaluation of the scale in three language versions (English, Spanish, and Korean). Lastly, we identified and removed items with potential cultural bias and duplicate functions to produce shorter versions of the scale, using item response theory (IRT). KEY RESULTS: We initially developed an 82-item DM-specific oral HL scale using the Rapid Estimate of Adult Literacy in Medicine (DM-REALM) model. To improve the clinical utility of the DM-REALM, we created shorter forms, a 40-item and 20-item version, and evaluated them by using IRT. All DM-REALM versions had high Cronbach alphas (.985, .974, and .945, respectively) and yielded sufficient convergent validity by positive correlations with existing functional HL scale (r = .49, p < .001), education (r = .14, p = .14 to r = .54, p < .001), and DM knowledge (r = .04, p = .70 to r = .36, p < .001). DM-REALM also demonstrated adequate sensitivity as an intervention evaluation tool that captures the changes induced by an intervention. CONCLUSIONS: All forms of the DM-REALM tool were reliable, valid, and clinically useful measures of HL in the context of DM care. Both researchers and clinicians can use this tool to assess DM-specific HL across multiple racial and ethnic populations. [HLRP: Health Literacy Research and Practice. 2020;4(4):e237-e249.] PLAIN LANGUAGE SUMMARY: This article reported the process and findings of a newly developed health literacy scale for people with diabetes mellitus using three different language versions. Both long and short versions of the scale demonstrated adequate validity and reliability.

Health Literacy and Outcomes of a Community-Based Self-Help Intervention: A Case of Korean Americans With Type 2 Diabetes.

BACKGROUND: Although scientific reports increasingly document the negative impact of inadequate health literacy on health-seeking behaviors, health literacy's effect on health outcomes in patients with diabetes is not entirely clear, owing to insufficient empirical studies, mixed findings, and insufficient longitudinal research. OBJECTIVE: The aim of this study was to empirically examine underlying mechanisms of health literacy's role in diabetes management among a group of Korean Americans with Type 2 diabetes mellitus. METHODS: Data from a randomized clinical trial of a health literacy-focused Type 2 diabetes self-management intervention conducted during 2012-2016 in the Korean American community were collected at baseline and at 3, 6, 9, and 12 months. A total of 250 Korean Americans with Type 2 diabetes participated (intervention, 120; control, 130). Participants were first-generation Korean American immigrants. Health literacy knowledge was measured with the original Rapid Estimate of Adult Literacy in Medicine and the diabetes mellitus-specific Rapid Estimate of Adult Literacy in Medicine. Functional health literacy was measured with the numeracy subscale of the Test of Functional Health Literacy in Adults and the Newest Vital Sign screening instrument, which also uses numeracy. Primary outcomes included glucose control and diabetes quality of life. Multivariate analyses included latent variable modeling. RESULTS: A series of path analyses identified self-efficacy and self-care skills as significant mediators between health literacy and glucose control and quality of life. Education and acculturation were the most significant correlates of health literacy. DISCUSSION: Despite inconsistent findings in the literature, this study indicates that health literacy may indirectly influence health outcomes through mediators such as self-care skills and self-efficacy. The study highlights the importance of health literacy, as well as underlying mechanisms with which health literacy influences processes and outcomes of diabetes self-management.

Food Sources of Sodium in Korean Americans With Type 2 Diabetes: Implications for Cardiovascular Disease.

INTRODUCTION: Excess sodium intake can increase the risk of high blood pressure and cardiovascular disease, common comorbidities for those with type 2 diabetes mellitus (T2DM). The purpose of this study is to describe sodium intake and high sodium food sources among Korean Americans (KAs) with T2DM. METHOD: This study, a descriptive, secondary analysis of baseline data from a clinical trial for diabetes, recruited KAs with T2DM ( n = 232) from the community. RESULTS: Average dietary sodium intake was 3,433 mg. Major sources of dietary sodium were from bicultural diets: noodles and dumplings, Korean-style soups, kimchi, breads and snacks, and boiled or seasoned vegetables. Participants who consumed excessive sodium were more likely to consume more calories and be male, married, and more recently diagnosed with T2DM. DISCUSSION: High consumption of sodium among KAs with T2DM supports the need to develop effective, tailored interventions addressing dietary sodium that incorporates the individual's culture.

Factors Predicting Sodium Intake of Korean Americans with Type 2 Diabetes.

The increasing prevalence of type 2 diabetes mellitus (T2DM) and its complications including cardiovascular disease and chronic kidney disease threaten Korean Americans (KAs). High dietary sodium intake contributes to both conditions. The purpose of the study was to assess dietary sodium consumption and to examine the predictors of sodium intake among KA with T2DM. A total 232 KA who had uncontrolled diabetes participated in this study. The majority of the sample (69%) consumed more sodium than current national guidelines. A high level of energy intake was the strongest predictor for sodium intake with gender and marital status also related. Our findings identified predictive factors to excessive sodium intake and these data support the need for culturally-tailored education about appropriate dietary sodium and energy intake are needed for patients about T2DM.

Predictors of suicidal ideation in Korean American older adults: analysis of the Memory and Aging Study of Koreans (MASK).

OBJECTIVE: Our aim is to investigate the prevalence and predictors of suicidal ideation among Korean American older adults and assess the self-rated mental health of Korean American older adults with suicidal ideation with or without depressive syndrome. METHODS: The Memory and Aging Study of Koreans is a cross-sectional, epidemiologic study of a community-representative sample of Korean American older adults (N = 1116) residing in the Baltimore-Washington area. Participants were interviewed using the Korean version of the Patient Health Questionnaire (PHQ-9K). In addition, demographic information, self-rated mental health, and self-rated physical health status were obtained. RESULTS: In this study, 14.7% of Korean American older adults reported suicidal ideation. Predictors of suicidal ideation included living alone, major or minor depressive syndrome (diagnosed by the PHQ-9K), shorter duration of residency in the USA, and poorer self-rated mental health status. Of those who reported suicidal ideation, 64% did not have minor or major depressive syndrome. However, their self-rated mental health was as poor as that of those with major or minor depressive syndrome but without suicidal ideation. CONCLUSION: Suicidal ideation without depressive syndromes was common among Korean American older adults. For this group of elders with poor self-rated mental health, future studies should look to improving early detection of suicide risks and developing feasible suicide prevention interventions. Copyright © 2016 John Wiley & Sons, Ltd.

Community Health Workers Versus Nurses as Counselors or Case Managers in a Self-Help Diabetes Management Program.

OBJECTIVES: To confirm the effectiveness of community health workers' involvement as counselors or case managers in a self-help diabetes management program in 2009 to 2014. METHODS: Our open-label, randomized controlled trial determined the effectiveness of a self-help intervention among Korean Americans aged 35 to 80 years in the Baltimore-Washington metropolitan area with uncontrolled type 2 diabetes. We measured and analyzed physiological and psychobehavioral health outcomes of the community health worker-counseled (n = 54) and registered nurse (RN)-counseled (n = 51) intervention groups in comparison with the control group (n = 104). RESULTS: The community health workers' performance was comparable to that of the RNs for both psychobehavioral outcomes (e.g., self-efficacy, quality of life) and physiological outcomes. The community health worker-counseled group showed hemoglobin A1C reductions from baseline (-1.2%, -1.5%, -1.3%, and -1.6%, at months 3, 6, 9, and 12, respectively), all of which were greater than reductions in the RN-counseled (-0.7%, -0.9%, -0.9%, and -1.0%) or the control (-0.5%, -0.5%, -0.6%, and -0.7%) groups. CONCLUSIONS: Community health workers performed as well as or better than nurses as counselors or case managers in a self-help diabetes management program in a Korean American community.

The Effect of a Community-Based Self-Help Intervention: Korean Americans With Type 2 Diabetes.

INTRODUCTION: Korean Americans are one of the most underserved ethnic/linguistic minority groups owing to cultural and institutional barriers; there is an urgent need for culturally competent diabetes management programs in the Korean American community for those with type 2 diabetes. The purpose of this study was to test the effectiveness of a community-based, culturally tailored, multimodal behavioral intervention program in an ethnic/linguistic minority group with type 2 diabetes. DESIGN: An RCT with waitlist comparison based on the Predisposing, Reinforcing, and Enabling Constructs in Education/environmental Diagnosis and Evaluation (PRECEDE)-Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development (PROCEED) and self-help models. Data were collected between September 2010 and June 2013 and were analyzed in August-December 2014. Statistical significance was set at p<0.05. SETTING/PARTICIPANTS: In a naturally occurring community setting, a total of 250 Korean Americans with type 2 diabetes were randomized into an intervention group (n=120) or a control group (n=130). INTERVENTION: The intervention consisted of key self-management skill-building activities through 12 hours of group education sessions, followed by integrated counseling and behavioral coaching by a team of RNs and community health workers. MAIN OUTCOME MEASURES: Primary (clinical) outcomes were hemoglobin A1c, glucose, total cholesterol, and low-density lipoprotein at baseline and at 3, 6, 9, and 12 months. Secondary (psychosocial and behavioral) outcomes included diabetes-related quality of life, self-efficacy, adherence to diabetes management regimen, and health literacy. RESULTS: During the 12-month project, the intervention group demonstrated 1.0%-1.3% (10.9-14.2 mmol/mol) reductions in hemoglobin A1c, whereas the control group achieved reductions of 0.5%-0.7% (5.5-7.7 mmol/mol). The differences between the two groups were statistically significant. The intervention group showed statistically significant improvement in diabetes-related self-efficacy and quality of life when compared with the control group. CONCLUSIONS: RN/community health worker teams equipped with culturally tailored training can be effective in helping an ethnic/linguistic minority group manage diabetes in the community.

Sources of Response Bias in Older Ethnic Minorities: A Case of Korean American Elderly.

The present study was undertaken to investigate potential sources of response bias in empirical research involving older ethnic minorities and to identify prudent strategies to reduce those biases, using Korean American elderly (KAE) as an example. Data were obtained from three independent studies of KAE (N = 1,297; age ≥60) in three states (Florida, New York, and Maryland) from 2000 to 2008. Two common measures, Pearlin's Mastery Scale and the CES-D scale, were selected for a series of psychometric tests based on classical measurement theory. Survey items were analyzed in depth, using psychometric properties generated from both exploratory factor analysis and confirmatory factor analysis as well as correlational analysis. Two types of potential sources of bias were identified as the most significant contributors to increases in error variances for these psychological instruments. Error variances were most prominent when (1) items were not presented in a manner that was culturally or contextually congruent with respect to the target population and/or (2) the response anchors for items were mixed (e.g., positive vs. negative). The systemic patterns and magnitudes of the biases were also cross-validated for the three studies. The results demonstrate sources and impacts of measurement biases in studies of older ethnic minorities. The identified response biases highlight the need for re-evaluation of current measurement practices, which are based on traditional recommendations that response anchors should be mixed or that the original wording of instruments should be rigidly followed. Specifically, systematic guidelines for accommodating cultural and contextual backgrounds into instrument design are warranted.

Economic evaluation of a community health worker-led health literacy intervention to promote cancer screening among Korean American women.

OBJECTIVE: The study's objectives were to calculate the costs and evaluate the cost-effectiveness of implementing a health literacy-focused intervention to promote breast and cervical cancer screenings among Korean American women overdue for these tests. METHODS: Researchers estimated the costs of a cluster-randomized controlled trial that evaluated this intervention. Effectiveness was measured as the number of breast or cervical cancer screenings received by women in either the intervention and control arms of the study. Cost-effectiveness was calculated as the incremental cost of each additional screening received by the intervention group. RESULTS: Comparing the intervention and control group, the incremental cost-effectiveness ratio was estimated to be US$236 per screening, without program development costs. CONCLUSION: These findings suggest this program, when compared with others, offered a more cost-effective approach for promoting cancer screening. Local health officials could use this information to guide decisions about reducing cancer disparities among recent immigrant women.

Prevalence and Predictors of Depression in Korean American Elderly: Findings from the Memory and Aging Study of Koreans (MASK).

OBJECTIVES: To estimate the prevalence and identify the predictors of depression among community-dwelling Korean American elderly (KAE). DESIGN: A cross-sectional descriptive epidemiological survey using a two-step sampling strategy to obtain a representative community sample. SETTING: The authors recruited study participants at religious, service, and business establishments in the KA community (26 churches, 6 senior centers, 2 medical daycare centers, 1 supermarket). PARTICIPANTS: Community-dwelling first-generation KAE (N = 1,118; mean age ± SD: 70.5 ± 7.0 years; female: 67.2%). MEASUREMENTS: Trained bilingual nurses and community health workers interviewed participants face-to-face for demographic information, chronic conditions, and depression using the Korean versions of the Patient Health Questionnaire (PHQ-9K). RESULTS: 30.3% of KAEs were classified as having either mild (PHQ-9K score 5-9; N = 218, 19.5%) or clinical depression (PHQ-9K score ≥10; N = 120, 10.8%), respectively. One of seven KAE (N = 164, 14.7%) endorsed thoughts of death or self-injury, but only 63 (5.7%) reported utilizing mental health services. The authors also identified several predictors of depression, including living arrangement (living alone versus living with family/spouse); having chronic conditions such as diabetes, arthritis, digestive disorders, or chronic bronchitis; years of education; and cognitive impairment. CONCLUSIONS: The authors' findings reveal a high prevalence of depression among KAE and a low level of mental health service utilization. Because there are urgent needs for culturally and contextually relevant interventions, the authors also discuss the feasibility of community-based interventions to reduce the burden of depression, which should be incorporated into a management system for multiple chronic conditions.

The effect of a community-based self-help multimodal behavioral intervention in Korean American seniors with high blood pressure.

BACKGROUND: Great strides have been made in improving heart health in the United States during the last 2 decades, yet these strides have not encompassed many ethnic minority populations. There are significant health disparity gaps stemming from both a paucity of valid research and a lack of culturally sensitive interventions. In particular, many Korean Americans with chronic illnesses encounter difficulty navigating the healthcare system because of limited health literacy. METHODS: The effect of a multimodal Self-Help Intervention Program on the Control of High Blood Pressure (HBP) was tested in a community-based clinical trial for Korean American seniors. Of 440 seniors enrolled, 369 completed the study (184 in the intervention group and 185 in the control group; mean age = 70.9±5.3 years). The intervention group received 6 weekly educational sessions on HBP management skill building, including health literacy training, followed by telephone counseling and home blood pressure (BP) monitoring for 12 months. RESULTS: Findings support that the Self-Help Intervention Program on the Control of HBP was effective in controlling BP in this ethnic/linguistic minority population. The BP control rates for the intervention and control groups were 49.5% vs. 43.2% at baseline, 58.5% vs. 42.4% at 6 months, 67.9% vs. 52.5% at 12 months, and 54.3% vs. 53.0% at 18 months. Significant changes were observed over time in some psychobehavioral outcomes, including self-efficacy for BP control, medication adherence behavior, HBP knowledge, and depression. CONCLUSIONS: The study findings suggest that the multimodal Self-Help Intervention Program on the Control of HBP is effective at promoting optimal HBP control for this ethnic/linguistic minority population. CLINICAL TRIALS REGISTRY: NCT00406614.

Mental health service utilization among Korean elders in Korean churches: preliminary findings from the Memory and Aging Study of Koreans in Maryland (MASK-MD).

BACKGROUND: Korean Americans (KA) comprise the fourth largest Asian-American subgroup, with a population estimated at nearly 1.7 million, and the vast majority (up to 85%) of KA elders attends ethnic churches. Despite the rapid increase of the KA elderly population, data on mental health service utilization among KA elders are scarce. METHOD: Based on a cluster sampling method, the Memory and Aging Study among Koreans in Maryland (MASK-MD) recruited and assessed 630 KA elders (mean age: 70.9 ± 6.1 years; 68.9% female) in KA churches for depression, dementia, and level of mental health service utilization. The Korean versions of the Patient Health Questionnaire (PHQ-9K) and Mini-mental Status Examination (MMSE-KC) were administered by trained community health workers. RESULTS: Of the 630 participants, 23.2% and 7.3% had PHQ-9 scores of 5 ('mild depression') or above and 10 or above ('clinical depression'), respectively. In addition, 7.0% scored below the age- and education-specific cutoff values for probable dementia based on the MMSE-KC. Of the 92 participants with 'clinical depression' or having thoughts of death or self-injury, only 16 (17%) reported utilizing mental health services. Likewise, of 56 participants with probable dementia, only 3 (7.3%) sought treatment from a health care provider. CONCLUSION: The prevalence of depression and cognitive impairment are high in community-dwelling KA elders attending KA churches, but the rate of mental health service utilization among depressed or cognitively impaired Korean elders is low. Further research is warranted to identify barriers to and strategies for adequate mental health care for Korean immigrant elders.

Feasibility and validity of dementia assessment by trained community health workers based on Clinical Dementia Rating.

OBJECTIVES: To determine the level of agreement between dementia rating by trained community health workers (CHWs) based on the Clinical Dementia Rating (CDR) and the criterion standard: physician diagnosis. DESIGN: Cross-sectional validation study. SETTING: Community gathering places such as ethnic churches, senior centers, low-income elderly apartments, and ethnic groceries in the Baltimore-Washington metropolitan area. PARTICIPANTS: Ninety community-dwelling Korean-American individuals aged 60 and older. MEASUREMENTS: The CDR is a standardized clinical dementia staging instrument used to assess cognitive and functional performance using a semistructured interview protocol. Six CHWs trained and certified as CDR raters interviewed and rated study participants. A bilingual geriatric psychiatrist evaluated participants independently for dementia status. RESULTS: CHWs rated 61.1% of the participants as having mild cognitive impairment (MCI; CDR = 0.5) or dementia (CDR≥1), versus 56.7% diagnosed by the clinician. A receiver operating characteristic (ROC) curve analysis demonstrated good predictive ability of CDR rating by trained CHWs (area under the ROC curve = 0.86, 95% confidence interval = 0.78-0.93, sensitivity = 85.5%, specificity = 88.6%) in detecting MCI and dementia. CONCLUSION: The findings provide preliminary evidence that trained CHWs can effectively identify community-dwelling elderly Korean adults with MCI and dementia for early follow-up assessment and care in a community with scarce bilingual caregivers and programs.

Translation and validation of the dietary approaches to stop hypertension for koreans intervention: culturally tailored dietary guidelines for Korean Americans with high blood pressure.

BACKGROUND: Lifestyle modification strategies such as adoption of the Dietary Approaches to Stop Hypertension (DASH) diet are now recognized as an integral part of high blood pressure (HBP) management. Although the high prevalence of HBP among Korean Americans (KAs) is well documented, few dietary interventions have been implemented in this population, in part because of a lack of culturally relevant nutrition education guidelines. Translating and testing the efficacy of culturally relevant dietary recommendations using a well-established dietary guideline such as DASH are imperative for promoting better cardiovascular health for this high-risk cultural group. OBJECTIVE: The aims of this study were to systematically translate and validate a culturally modified DASH for Koreans (K-DASH) and obtain preliminary evidence of efficacy. METHODS: A 2-step approach of intervention translation and efficacy testing, together with close adherence to principles of community-based participatory research, was used to maximize community input. A 1-group pre-post design with 24-hour urine and 24-hour ambulatory blood pressure monitoring comparisons was used to test the initial feasibility and efficacy of the K-DASH intervention. RESULTS: A total of 28 KAs with HBP participated in a 10-week dietary intervention consisting of group education sessions and individual counseling. Both systolic blood pressure and diastolic blood pressure, as measured by ambulatory blood pressure monitoring, were significantly decreased at postintervention evaluation (systolic blood pressure, -4.5 mm Hg; diastolic blood pressure, -2.6 mm Hg; P < .05). Serum low-density lipoprotein cholesterol was significantly decreased (-7.3 mg/dL; P < .05). Serum potassium and ascorbic acid levels were also improved in the reference range. Urine potassium level was significantly increased, supporting increased fruit and vegetable consumption. CONCLUSION: This pilot study has (a) demonstrated that a cultural adaptation of DASH using community-based participatory research methodology produced a culturally relevant and efficacious dietary intervention for the KAs with HBP and (b) provided strong preliminary evidence for the efficacy of the K-DASH intervention in reducing HBP in hypertensive KAs.

Development and validation of the high blood pressure-focused health literacy scale.

OBJECTIVE: While the role of health literacy in chronic disease management is well documented, few intervention studies have been reported. A major barrier to designing and implementing such interventions is the lack of valid health literacy tools. This study developed and tested a novel health literacy scale for individuals with high blood pressure (HBP). METHODS: A two-step design process was used: In the construction phase, focus group studies and a literature review were conducted to generate a pool of items. The testing phase involved a psychometric evaluation and pilot-testing of the scale on hypertensive Korean Americans (n=386). The end product was a HBP-health literacy scale (HBP-HLS) with two essential domains, print literacy and functional health literacy. RESULTS: Psychometric testing indicated that the scale was reliable (Kuder-Richardson-20 coefficient=0.98), valid (content validity index ≥0.8), and significantly correlated with theoretically selected variables (education, r=0.67, p<0.01; HBP knowledge, r=0.33, p<0.01). CONCLUSION: The HBP-HLS demonstrated its utility for evaluating HBP management interventions in the community setting. PRACTICE IMPLICATIONS: Utilizing the HBP-HLS should be considered as a potential tool for improving health literacy and evaluating intervention studies in the context of HBP management.

Utility of a point-of-care device in recruiting ethnic minorities for diabetes research with community partners.

BACKGROUND: Recruitment of hard-to-reach ethnic minorities such as Korean Americans (KAs) requires substantial time, cost, and strategic effort. A point-of-care (POC) A1c test could facilitate the recruitment of such populations for diabetes research in community settings. METHODS: A two-step approach for participant screening was employed: Potential participants were first screened using the POC A1c test at a community location. Only those with POC A1c levels ≥7.5% were referred for a confirmatory lab test within two weeks. RESULTS: In total, 237 KAs were screened using the POC A1c test; 92 were referred for confirmatory testing and 83 who got the laboratory A1c measurement were confirmed eligible (A1c ≥7.5%). There was a strong positive correlation between the POC and reference laboratory measurements (ρ=0.83, p≤.001). CONCLUSION: Using a POC A1c method as a front-line screening test can facilitate the recruitment of KAs with type 2 diabetes, while saving cost, time, and effort.

Teletransmitted monitoring of blood pressure and bilingual nurse counseling-sustained improvements in blood pressure control during 12 months in hypertensive Korean Americans.

This paper reports the results of a clinical investigation to determine the sustainability of intervention effects to lower blood pressure (BP) that were obtained through a short-term education via home telemonitoring of BP and regular counseling by bilingual nurses during 1 year. A total of 359 middle-aged (40-64 years) Korean immigrants completed a 15-month intervention that consisted of 6-week behavioral education followed by home telemonitoring of BP and bilingual nurse telephone counseling for 12 months. The final analysis revealed a sharp increase in BP control rates sustained for more than 12 months. At baseline, only 30% of the sample achieved BP control (<140/90 mm Hg). After the initial education period (approximately 3 months), 73.3% of the participants had controlled BP levels. The levels of control were maintained and continuously improved during a 12-month follow-up period (83.2%, P<.001). These findings suggest that home telemonitoring of BP and tailored counseling are both useful tools to sustain or improve short-term education effects.

Measuring health literacy among immigrants with a phonetic primary language: a case of Korean American women.

While the need for understanding the issue of health literacy among ethnic minority groups with limited English skills is rapidly increasing in the US, it is difficult to find valid and useful health literacy tools for certain linguistic minorities. This study was designed to validate the Korean translation of Rapid Estimate of Adult Literacy in Medicine (REALM) and Test of Functional Health Literacy in Adults-Short form (S-TOFHLA). Korean REALM and S-TOFHLA were administered to 98 Korean American women, together with REALM-English. Participants were first-generation immigrants who were educated in Korea. Both Korean REALM and S-TOFHLA resulted in a negatively-skewed distribution. REALM-English yielded well-distributed groups with significant correlations with Korean REALM and S-TOFHLA (Spearman's rho = 0.30, P = 0.003 and 0.22, P = 0.03, respectively). Educational level was significantly correlated with REALM-English and Korean S-TOFHLA (Spearman's rho = 0.39, P = 0.000 and 0.25, P = 0.014), but not with REALM-Korean. The translation of REALM and S-TOFHLA into the Korean language did not lead to a valid assessment of health literacy. A more systematic approach is needed to assess health literacy in immigrants with limited English skills, particularly those with a phonetic primary language. Meanwhile, REALM-English could be used as a crude health literacy test for individuals with some English skills.

Translating current dietary guidelines into a culturally tailored nutrition education program for Korean American immigrants with type 2 diabetes.

PURPOSE: The purpose of this article is to describe the process of translating evidence-based dietary guidelines into a tailored nutrition education program for Korean American immigrants (KAI) with type 2 diabetes mellitus (DM). METHODS: Community-based participatory research (CBPR) is a research process involving researchers and communities to build a collaborative partnership. The study was conducted at a community-based organization. In a total of 79 KAI (intervention, n = 40; control, n = 39) with uncontrolled type 2 DM (A1C ≥ 7.5%), 44.3% were female and the mean age was 56. 5 ± 7.9 years. A culturally tailored nutrition education was developed by identifying community needs and evaluating research evidence. The efficacy and acceptability of the program was assessed. RESULTS: In translating dietary guidelines into a culturally relevant nutrition education, culturally tailored dietary recommendations and education instruments were used. While dietary guidelines from the American Diabetes Association (ADA) were used to frame nutrition recommendations, additional content was adopted from the Korean Diabetes Association (KDA) guidelines. Culturally relevant intervention materials, such as Korean food models and an individually tailored serving table, were utilized to solidify nutritional concepts as well as to facilitate meal planning. Evaluation of the education revealed significantly increased DM-specific nutrition knowledge in the intervention group. The participants' satisfaction with the education was 9.7 on a 0 to 10-point scale. CONCLUSION: The systematic translation approach was useful for producing a culturally tailored nutrition education program for KAI. The program was effective in improving the participants' DM-specific nutrition knowledge and yielded a high level of satisfaction. Future research is warranted to determine the effect of a culturally tailored nutrition education on other clinical outcomes.

Compliance with home blood pressure monitoring among middle-aged Korean Americans with hypertension.

The primary objective of this study was to investigate the factors affecting the level of compliance of home blood pressure monitoring (HBPM) and its relation to blood pressure (BP) control among hypertensive adults in a community setting. A total of 377 middle-aged Korean Americans with high BP participated in this study. Along with structured behavioral education, the participants were instructed to measure their BP 3 times in a row upon waking and thrice again at bedtime, at least 2 or more times a week for 48 weeks. Using multivariate logistic regression, the authors examined the patterns and factors affecting HBPM and its relation to BP control status. The analyses revealed that older participants were more compliant with the HBPM instruction than were younger participants (adjusted odds ratio [OR], 5.29; 95% confidence interval [CI], 1.77-15.81) and those with more depressive symptoms were less compliant (OR, 0.19; 95% CI, 0.04-0.88). Participants who were more compliant to HBPM instruction were 4 times more likely than those who were noncompliant to have controlled their BP by the end of the intervention period (OR, 4.28; 95% CI, 1.79-10.23). These results suggest that the participants who checked their BP regularly at home had a stronger tendency to achieve BP control.