The effects of a walking program on older Chinese American immigrants with hypertension

This study examined the effects of a walking program with and without cultural modification among older Chinese American immigrants with hypertension. The study framework was based on Self-Efficacy Theory, Stages of Change Model, and Culture Care Theory and used a two-group, pretest-posttest, quasi-experimental design. Subjects (N = 128) were assigned to a non-culturally modified (n = 70) or culturally modified (n = 58) walking group. The first group received an 8-week walking program adapted from a protocol by Jitramontree (2001). The second group received the same 8-week walking program but culturally modified for Chinese Americans. The hypotheses were that stages of change and participation in a walking program with/without cultural modification would affect the dependent variables: perceived barriers, self-efficacy, blood pressure, and duration of walking. The results showed no interaction between stages of change and groups in the dependent variables. In addition, no main effects of stages on dependent variables were found except for duration of walking. These results revealed that individuals in the maintenance stage walked longer than those in the preparation stage. Main effects of the walking program were found on self-efficacy and barriers of social influences, lack of willpower, and lack of skill, but not on blood pressure and duration of walking. Participants in the non-culturally modified walking program had fewer barriers of social influence, lack of willpower, and lack of skill, and their confidence increased compared to those in the culturally modified walking program. Duration of physical activity at pretest was found to significantly affect posttest measures of diastolic blood pressure, self-efficacy, and the barriers of lack of willpower and lack of skill. Moreover, participants who walked more than 210 minutes/week had fewer barriers and were more confident in walking than those who walked less than 210 minutes/week. These results suggest that this walking protocol, when translated into Chinese and when accompanied by a weekly telephone reminder and other interactions with a Chinese-speaking nurse, is appropriate to use without additional cultural modification in older Chinese American immigrants with hypertension. Future research needs to examine other components of Chinese culture or to apply this protocol to Chinese Americans with other chronic diseases