Kaya KO!: A Health Education Model to Address Hypertension among Filipino Immigrants in the US and Globally

Emerson E. Ea, PhD, DNP, APRN, CNE

Clinical Associate Professor & Assistant Dean, Clinical and Adjunct Faculty Affairs

New York University Rory Meyers College of Nursing

Hypertension (HTN), a key risk factor for cardiovascular disease, remains a growing public health problem in the United States. According to the Centers for Disease Control, 29% of non-institutionalized adults ages 20 and over have HTN in the U.S.  Rates of HTN are even higher in racial and ethnic communities in the United States. Several studies conducted among Filipino immigrants in the U.S. indicate that this population possesses a disproportionately higher burden of HTN compared with Whites and other Asian and Pacific Islander groups.^{1, 2} Also, there are studies that indicate that the prevalence of HTN among Filipinos approaches and, in some cases, exceeds that of African Americans.³

Filipino immigrants belong to the third largest group of Asian immigrants in the US (Pew Research Center, 2018).⁴ Results of several studies indicate that Filipino immigrants are at increased risk for HTN due to numerous risk factors, including low levels of HDL cholesterol and high rates of smoking, physical inactivity, and high body mass index (BMI).^{1, 2, 3} Studies also show their poor disease management is due to several factors, including low medication adherence; a lack of culturally and linguistically appropriate screening and educational materials; limited knowledge of health care systems; and lack of health insurance. ^{1, 2, 3}

Self-care or the ability to adopt and maintain a healthy lifestyle has been shown to significantly relate to the diagnosis of HTN across racial and ethnic groups. In addition, optimal HTN self-care behaviors such as adherence to taking anti-hypertensive medication, following a low salt or fat diet, exercising on a regular basis, keeping regular physician visits, and reduction of stress could lead to a decrease in blood pressure, decrease in all-cause mortality rate, and a lower risk in developing stroke and other cardiovascular diseases across racial and ethnic groups. ⁵ Although there is a growing literature that explore the factors that relate to the diagnosis and management of HTN among Filipino immigrants in the US, there is a significant lack of information that explore self-care among Filipinos in the US who have HTN.⁶ To address this knowledge gap, I conducted a study to explore self-care among Filipino immigrants who have HTN.^{6, 7} Findings of the study revealed that HTN self-efficacy and patient activation are predictive of HTN self-care for the sample in the study.⁷ In addition, patient activation was also found to help the relationship between HTN self-efficacy and HTN self-care.⁷

To translate these study findings into clinical practice, I developed a heart health education model, Kaya Ko! (translates to “I CAN” in English) that incorporated the Filipino language, shared cultural values and identity, and lived experiences of Filipino immigrants who have hypertension. ⁸ The model, KAYA KO! is also an acronym that stands for behaviors and actions coined in the Filipino language that influence heart health (http://bit.ly/Kayako). The letter K stands for Kilos (or activities/exercise in Filipino), A for Alak (alcohol intake), Y for Yosi/Sigarilyo (cigarette smoking), A stands for Alta Presyon (high blood pressure) and KO! for Kompiyansa para sa Kalusugan (or Confidence for Health and Well-Being in Filipino language). The term, Kaya Ko is also a common Filipino catchphrase that captures the shared Filipino cultural values and beliefs of resilience, self-confidence, determination, and perseverance. The activities and actions described in Kaya KO! are based on American Heart Association’s definition of self-care that relate to cardio-vascular disease management. Health care providers and health educator professionals may use this health education model to engage and motivate Filipino immigrants to adopt and/or maintain heart health activities. To date, this health education model has been shared and accessed by thousands of Filipinos in 16 countries, and adopted by Filipino immigrant organizations in the US and globally.

 

References

¹Ursua, R., Aguilar, D., Wyatt, L., Tandon, S. D., Escondo. K., Rey, M., & Trinh-Shevrin, C. (2014). Awareness, treatment and control of hypertension among Filipino immigrants. Journal of General Internal Medicine, 29(3), 455-462.

²Ursua, R. A., Aguilar, D. E., Wyatt, L. C., Katigbak, C., Islam, N. S., et al. (2014). A community health worker intervention to improve management of hypertension among Filipino Americans in New York and New Jersey: A pilot study. Ethnicity & Disease, 24(1), 67-76.

³Ursua, R. A., Islam, N. S., Aguilar, D. E., Wyatt, L. C., Tandon, S. D., et al. (2013). Predictors of hypertension among Filipino immigrants in the Northeast US. Journal of Community Health, 38(5), 847-855.

⁴Pew Research Center Social and Demographic Trends (2018). Key facts about Asian Americans, a diverse and growing population. Retrieved from http://www.pewresearch.org/fact-tank/2017/09/08/key-facts-about-asian-americans/

⁵Fan, A. Z., Mallawaarachchi, D. S., Gilbertz, D., & Mokdad, A. H. (2010). Lifestyle behaviors and receipt of preventive health care services among hypertensive Americans aged 45 years or older in 2007. Preventive Medicine, 50(3):138-142. doi: 10.1016/j.ypmed.2009.12.007.Schroder, Fahey, & Ebrahim, 2004

⁶Ea, E., Colbert, A., Turk, M., & Dickson, V. (2018). Self-care among Filipinos in the United States who have hypertension. Applied Nursing Research, 39, 71-76. doi.org/10.1016/j.apnr.2017.11.002

⁷Ea, E., Colbert, A., Turk, M., & Dickson, V. (2018, in press). An overview of hypertension among Filipino Americans: Implications for research, practice, and health policy. The Journal of Nursing Practice Applications & Reviews of Research.

⁸Ea, E. (2017). Kaya KO!: A campaign for better health for Filipinos by Filipinos. Retrieved from http://kayakoforhealth.org/