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A Community and Culture-Centered Approach to Developing Effective Cardiovascular Health Messages

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Abstract

Objective

Little is known about how best to target cardiovascular health promotion messages to minorities. This study describes key lessons that emerged from a community and culture-centered approach to developing a multimedia, coronary heart disease (CHD) patient education program (PEP) for medically underserved South Asian immigrants.

Methods

The prototype PEP integrated the surface structures (e.g. language) and deeper structures (e.g. explanatory models (EMs), values) of South Asians' socio-cultural context. Seven focus groups and 13 individual interviews were used to investigate South Asians’ reactions and obtain qualitative feedback after viewing the culturally targeted PEP. Qualitative data were organized into emergent thematic constructs.

Results

Participants (n = 56) mean age was 51 years and 48 % were Hindi speakers. Community members had a strong, negative reaction to some of the targeted messages, "This statement is a bold attack. You are pin-pointing one community." Other important themes emerged from focus groups and interviews about the PEP: 1) it did not capture the community’s heterogeneity; 2) did not sufficiently incorporate South Asians’ EMs of CHD; and 3) did not address economic barriers to CHD prevention. Feedback was used to revise the PEP.

Conclusion

A community and culture-centered approach to developing cardiovascular health promotion messages revealed tensions between the researcher’s vantage point of “cultural targeting” and the community’s perceptions and reactions to these messages. Engaging communities in every phase of message design, incorporating their EMs, recognizing community heterogeneity, and addressing economic and structural barriers, are critical steps to ensuring that health promotion messages reach their intended audience and achieve true cultural appropriateness.

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Acknowledgments

This study was funded by the National Heart, Lung, and Blood Institute (Career Development Award 5 K23 HL 084177, PI-Dr. Kandula). An earlier version of this paper was presented at the Society of General Internal Medicine’s 34th Annual Meeting, Phoenix, Arizona, on 05/04/11. The authors thank Metropolitan Asian Family Services, Asian Human Services Family Health Center, and Indo-American Center in Chicago, IL for their assistance with recruitment. We also thank Marla Clayman, PhD for her comments on an earlier version of this paper.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Authors and Affiliations

  1. Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA

    Namratha R. Kandula MD, MPH, Neerja R. Khurana BDS MPH, Sara Glass RD & David W. Baker MD, MPH

  2. Saint Francis Hospital and Medical Center, Hartford, CT, USA

    Gregory Makoul PhD

  3. Northwestern University, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA

    Namratha R. Kandula MD, MPH

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  1. Namratha R. Kandula MD, MPH
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  2. Neerja R. Khurana BDS MPH
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  5. David W. Baker MD, MPH
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Correspondence to Namratha R. Kandula MD, MPH.

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Kandula, N.R., Khurana, N.R., Makoul, G. et al. A Community and Culture-Centered Approach to Developing Effective Cardiovascular Health Messages. J GEN INTERN MED 27, 1308–1316 (2012). https://doi.org/10.1007/s11606-012-2102-9

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