understanding the needs of hypertensive filipino … · filipino americans have quickly become one...

Running head: UNDERSTANDING THE NEEDS OF HYPERTENSIVE FILIPINO AMERICANS 1

Understanding the Needs of Hypertensive Filipino Americans

Joseph Ison

Integrative Health Seminar

California Institute of Integral Studies

Allyson Washburn

May 8, 2014

UNDERSTANDING THE NEEDS OF HYPERTENSIVE FILIPINO AMERICANS 2

TABLE OF CONTENTS

Abstract………………………………………………………………………………..………......3

Introduction………………………………………………………………………………………..4 An Understudied Population………………………………………………………………4 High Prevalence of Hypertension Among Filipino Americans…………………………...5 Purpose of Research………………………………………………………………………..……...6 Importance of Research………………………………………………………………………..….7 Autobiographical Statement…………………………………………………………………….....8 Literature Review……………………………………………………………………………….....9 Prevalence of Hypertension in Filipino Americans…………...…………………………10 Recognizing the Need for Culturally-tailored Health Interventions……………………..14 Effects of Filipinos’ Cultural Beliefs and Perceptions About Illness on Their Health.….17 A Difference Approaching to Managing Hypertension………………………………….20 Summary and Conclusion………………………………………………………………..22 Methodology…………………………………………………………………………………......24 Participants and Location………………………………………………………………...24

Procedure………………………………………………………………………………...25 Focus Group Questions…………………………………………………………………..28 Hypertension Experience Questions……………………………………………..28 What Would it Look Like Questions…………………………………………….29

Analysis…………………………………………………………………………………………..29 Implications of Research…………………………………………………………………………30 Limitations and Ethical Considerations………………………………………………………….33 Discussion………………………………………………………………………………………..34 Summary………………………………………………………………………………………....36 Bibliography……………………………………………………………………………………..39 Appendix A What Would it Look Like Questions Translated in Tagalog……...……………………..43


Abstract Filipino Americans have quickly become one of the fastest growing ethnic minorities in the

United States. The 2010 US Census reported that at 3.4 million, Filipino Americans were the

second largest Asian American subgroup in the United States just behind Chinese Americans at 4

million. Current studies show a high prevalence and poor control of hypertension in Filipino

Americans when compared to other Asian Americans and Caucasians. The purpose of this

modified thesis is to better understand the needs of hypertensive Filipino Americans in relation

to improving management of their blood pressure. Focus groups designed from an integrative

health perspective will be used to explore participants’ experiences with lifestyle, self-care

practices, healthcare provider experience, and cultural factors that will likely reveal barriers to

successfully managing their blood pressure. Implications of this research include valuable

observations of the common themes around information and treatment resources, what a positive

experience with their health provider looks like, and ways in which they feel like they are able to

control their hypertension.

Keywords: Filipino American, high blood pressure, hypertension, hypertensive Filipino

Americans, integrative health


Chronic disease in the United States is more commonplace than it has ever been in the

nation’s history. Diabetes, stroke, heart disease, and cancer are some of the most common

chronic diseases that are also some of the most costly and preventable with healthy lifestyle

practices (CDC, 2013). High blood pressure, also known as hypertension, is a serious risk factor

that when uncontrolled, can lead to serious chronic diseases such as cardiovascular disease and

diabetes. The Centers for Disease Control (2013) reports that one in three American adults have

hypertension. Hypertension is medically defined as persistent elevation of systolic blood pressure

at a level of 140 mmHg or higher, diastolic blood pressure at a level of 90 mmHg or higher, in

addition to being on medication for high blood pressure (CDC, 2013).

An Understudied Population

When specifically looking at the academic literature that is currently available on

hypertension in the Asian population in the United States, Filipino Americans are consistently

found to have the highest rates of hypertension, while also having poor control of their blood

pressure. While the Centers for Disease Control defines controlled hypertension as having a

systolic blood pressure measuring below 140mm Hg and a diastolic blood pressure below 90

mmHg (CDC, 2013), statistics do not account for how Filipino Americans interpret this

definition in relation to their treatment. The current research available does not fully explain why

Filipino Americans continue to have difficulty managing their blood pressure, and the impact

that contextual and cultural influences may contribute to how they view treatment. For the

purposes of this paper, Filipino American is defined as any Filipino, born in the Philippines or

United States, currently living in the United States. With a population of roughly 3.4 million

people in the United States, Filipinos comprise the second largest Asian subgroup behind

Chinese Americans (CDC, 2011). In 2010, the US Census Bureau reported that northern and


southern California had the highest concentrations of Filipinos in the United States. In this same

study, Filipinos were reported as the largest Asian American subgroup in California at 43.2%

ahead of the Vietnamese population at 37.3%. The increase in population and presence of

Filipino Americans in the United States is expected to grow over time. Because of this, it is

important to consider more research efforts for a growing population that struggles with chronic

illness. This phenomenon combined with national data and statistics that continually report a

high prevalence of hypertension among Filipino Americans speaks to the alarming health

disparity that exists to which little attention has been brought. In a 2000 study on the prevalence

of risk factors and outcomes of treatment in Filipino Americans living with coronary heart

disease, Ryan et al. assert that very little has been published on the health of Filipino Americans.

High Prevalence of Hypertension Among Filipino Americans

In a 2014 article studying the variation of hypertension prevalence among Asian

Americans subgroups, the authors found Filipinos to have a high prevalence of hypertension

when compared with other Asian Americans (Jose, Zhao, Chung, Fortmann, & Palaniappan,

2013). Authors reported that Filipinos had a 51.2% rate of hypertension while the other Asian

American subgroups had lower rates; Chinese at 29.8%, Koreans at 30.7%; Vietnamese at

30.8%, Asian Indians at 36.9%, and Japanese at 38.2%. As a result of heterogeneity displayed in

their study, the authors underline the need for studying different Asian American subgroups

individually. When two studies conducted 25 years apart on the awareness, treatment, and

management of hypertension in Filipino Americans were compared, it was a shocking realization

that no significant improvements have been made. Stavig, Igra, and Leonard’s study (1988)

using the 1979 California Hypertension Survey showed Filipino Americans to have the most

awareness and likelihood to be under medical treatment, but had poor management of their


hypertension disproportionate to other Asian American groups. The latter study was a cross-

sectional survey study on the awareness, treatment, and control of hypertension among Filipino

Americans conducted by Ursua et al. (2013), which reported that a mere 21.7% of their 566

hypertensive participants had their blood pressure under control. These two articles will be

reviewed in more detail in literature review. It was apparent to me that more studies are needed

to examine the underlying causes of poor blood pressure management. As the lack of

improvement in hypertension management spanning the past 25 years has shown, there is a need

to continue studying the health issues of Filipino Americans, as well as to consider the impact

that an integrative approach could have on the development of effective health interventions.

Purpose of Research

The purpose of this modified thesis is to address the issue of how to better understand the

needs of hypertensive Filipino Americans in relation to improving management of blood

pressure. This paper specifically explores daily lifestyle and self-care practices of Filipino

Americans, their experiences with health interventions and barriers to health, as well as possible

cultural influences that factor into control of their blood pressure. With the urgency for more

culturally-specific health studies in mind, the hopes of this research on a larger scale is to

produce qualitative data that can be evaluated as potential guidelines for tailoring health

programs and interventions around lifestyle change and behavior modification, applicable to all

ethnic minorities with a serious health condition. The broad category of “Asian American”

simply does not allow for any recognition of differences, great or small, in cultural and

traditional beliefs about health issues (Gong, Gage, & Tacata, 2003). It is also the aim of this

modified thesis to reveal what kind of impact focus groups, designed and executed from an

integrative health perspective, would have on improving our understanding the specific needs of


Filipino Americans so that health interventions can be developed accordingly. Although the

conventional Western model of health and illness is used when studying common health issues

such as hypertension, the emerging field of integrative health has yet to be fully considered when

researching the health of Asian American subgroups. There is an overarching significance in

raising awareness, addressing cultural and behavioral factors, and identifying how various Asian

American subgroups regard their health in ways they can truly identify with.

Importance of Research

The importance of studying the health of Filipino Americans centers around the fact that

they have been often referred to as the “invisible Asian.” In an interview I conducted with Dr.

Cricel Molina, who recently completed her dissertation A Qualitative Exploration of the Effect of

Age at Migration on the Acculturative Processes of Filipino Immigrants: Implications for Public

Health Studies (2012), she expressed that there is a small number of researchers conducting

qualitative studies and studies in general, on issues unique to Filipino Americans and their health

(Personal communication, April 8, 2014). Furthermore, she revealed that although there is a lack

of research on Filipino Americans, there are very few Filipino Americans studying the issues of

their own ethnicity. The investment of my time, efforts, and passion in conducting research

among Filipino Americans is motivated by this fact that there is a scarce number of researchers

examining the experiences and dynamic cultural factors that play a role in the health outcomes of

this population.

In 2008, dela Cruz and Galang conducted a focus group study similar to the one I propose

and found that Filipino Americans attribute their hypertension to the biomedical model of health

in terms of causes, consequences, and treatment. They concluded that Filipino Americans living

with hypertension struggle with maintaining the healthy lifestyle choices that would improve


control of their blood pressure. The importance of this thesis also aims to build on dela Cruz and

Galang’s research and additionally looks to explore how a complementary, alternative, and

integrative modality (CAIM) like wellness coaching, might affect the management of high blood

pressure.

Autobiographical Statement

Having been born in the United States as a second generation Filipino American, I grew

up learning traditional Filipino values and customs as my parents and relatives introduced them

to me. In schools, hospitals, and government application forms, falling under the Asian

American category with no “Filipino American” or “Filipino” box to check was something that

became second nature and I never had any reason to question it. Doctors visits and routine

checkups were normal things I experienced growing up, and it was not until the past several

years that I have allowed myself to actively engage with my own health and the health concerns

of others. Imbedded within my teenage years and up until very recently, I was living with

eczema, a condition where one’s skin becomes inflamed, dry, and itchy. Eczema became a

chronic condition as I went from dermatologist to dermatologist in search for ways to heal my

skin. It took over ten years for me to finally seek treatment without the use of steroidal creams

and ointments. Focusing on alternative healing methods, I’ve been met with success in treating

my eczema from natural ways without having to rely on ointments. Consequently, by

overhauling my diet, increasing mindfulness in my daily life, and shifting my overall perspective

and approach to health, I have become a healthier human being. It was during this time that I

became interested in viewing health and chronic conditions from perspectives outside the

conventional Western model of health. I had been used to thinking about health and illness from

the perspective that our minds and bodies operate independently of one another and that treating


health conditions needed to be addressed as such. This was a very reductionist approach to

health, as opposed to an integrative perspective taking into account the interplay of mind, body,

spirit, and environment. The shift of giving power back to myself without dependency on

allopathic interventions such as prescription creams and ointments has brought to light new and

sustainable practices of health and self-care. It was through these experiences of growth that I

have realized the need for more awareness around the health of Filipino Americans.

As the urgency of health and well-being have come to the forefront of my life, the lack of

studies on the health of Filipino Americans in addition to being aggregated under the Asian

American umbrella, is an issue that has come full circle. My experience in having to seek out

complementary and alternative modalities for living with a chronic condition prompted academic

inquiry and advocacy for topics that have remained understudied. The question of why there is

no box to check for Filipinos on any type of form is an issue that affects every ethnicity that is

invisible under the Asian American category and beyond. Though Asian Americans are one of

the most rapidly growing ethnic populations in America, there are many health researchers that

suggest the need for more knowledge about how various Asian American groups view health and

how they utilize the health care options accessible to them. The more health-related studies and

data that are available on specific Asian American ethnicities, the better informed and more

efficient doctors, healers, and public health providers can be in creating health services for these

groups in a way that honors their cultural backgrounds (Huang, Appel, Nicdao, Lee, & Ai,

2012).

Literature Review

A survey of the current literature available on the health of Filipino Americans reveals

evidence of the critical need for additional scholarly work that includes research from the field of


integrative health in addition to the allopathic model of medicine and care. Conducting the

literature review was an exploratory process. Because there are very few studies on Filipino

Americans with a integrative health perspective, there was a certain degree of freedom in

choosing which pieces of scholarly works and journal articles to review. The lack of updated

studies on hypertension issues in Filipino Americans also limited my options, and some of the

key works reviewed are seen as relevant, despite being older than five years. In addition,

important literature on health promotion programs and wellness coaching was included to help

support the integrative health perspective. Finally, the literature review concludes with a short

summary highlighting the important themes.

Prevalence of Hypertension in Filipino Americans

A few key articles highlight the prevalence of hypertension among Filipino Americans.

As mentioned earlier, one of the older yet commonly cited articles on hypertension in Asian

Americans that included Filipino Americans is the extensive study published in 1988 by Igra,

Leonard, and Stavig, that examined the blood pressure of 8,353 adults living in California,

including 1,757 Asians and Pacific Islanders. Though they briefly mention the frequency of

participants’ visits to a physician, the level of access and nature of healthcare quality was not

explored in depth within this study. Under the Asian and Pacific Islander grouping, prevalence

rates were determined separately for Filipinos, Chinese, Japanese and other Asians and Pacific

Islanders. In addition to taking measurements of blood pressure, participants were also asked

questions about the level of understanding of their hypertension. Overall, they found that “the

prevalence of controlled and uncontrolled hypertension in the United States is lower for persons

ethnically classified as Asian, particularly Japanese and excepting Filipinos, than for the general

population” (pg. 28). Although this study dates back 25 years, the results showed a significant


difference among Asian ethnicities where Japanese had the lowest rates of hypertension, while

Filipinos had the highest rates, second overall to African Americans. When the results were

examined further, prevalence of hypertension in both Filipino men aged 18 to 49 (30.5%)

exceeded that of blacks (28.3%) and Filipino women 50 and older (65.2% versus 63.1%), further

highlighting the disproportionate rates of hypertension among Asian Americans. Interestingly,

however, they found that although Filipinos had the highest rates of hypertension and were the

most likely to be aware and under treatment of any Asians and Pacific Islanders, they also

showed poor control and management of their high blood pressure. Only 8% of Filipinos were

considered to have their blood pressure under control, even though 63% were most likely to be

aware, and almost half were under treatment. In their discussion about treatment, the authors

reported that Filipinos were more likely to follow alternative, non pharmacological therapies

including diets and salt restriction, exercise, and stress reduction among other things. After

contemplating these findings, it was apparent how valuable health promotion programs and

health education materials played a role in this population. It is clear that neither awareness of

their hypertensive condition nor being under treatment were sufficient or effective for controlling

their blood pressure. With this article being one of the most extensive and earlier studies on

hypertension in Asian Americans that included analysis on Filipinos, the authors shed light on

the lack of health resources, educational programs and materials directed at specific Asian

Americans subgroups.

Fast forward over 25 years to two related studies both published in 2013 by Rhodora

Ursua, a health professional with over nine years of experience studying cardiovascular health of

Filipino Americans. One study examined the awareness, treatment, and control of hypertension,

and the other focused on risk factors. The first thing worth noting in both studies were the


authors’ view that little research has been conducted on hypertensive Filipino Americans. This

echoed the sentiments that Stavig, Igra, and Leonard had in their literature review of the 1988

study on hypertension, stating the issue around the lack of published studies that focus on blood

pressure issues in Asians and Pacific Islanders. This was an astounding observation made

between two articles written over 25 years apart. The research of Ursua and colleagues were two

of the few articles from the past several years that have specifically studied the experience of

hypertensive Filipinos, making them important in this literature review.

The Ursua et al. study (2013) aimed to identify hypertension rates as well as the factors

related to awareness, treatment, and control. With the cross sectional analysis of survey data

from health screenings, their findings revealed that of 566 participants, only 21.7% had their

blood pressure under control, even though almost 75% were aware of their condition and over

half were on medication. These findings resemble what Igra, Leonard, and Stavig reported on

issues of hypertension among Filipino Americans 25 years ago with a high rate of Filipino

participants having awareness of their condition, and low numbers for those with their blood

pressure under control.

The second study from Ursua et al. (2014) looked at the predictors of hypertension in

Filipino Americans in the New York City area. Similar to many of the conclusions posed in

journal articles examining health issues of Filipinos, Ursua et al. state that the existing research

on hypertension in this population is outdated and scarce. While the need for more studies may

be concurrent among researchers, the number of peer-reviewed articles on Filipino American

health does continues to increase, as pointed out in an interview conducted with a researcher

studying hypertensive Filipino Americans (Anonymous researcher, personal communication,

April 13, 2014). Ursua et al. claim that their study is the first of its kind to strictly examine a


Filipino population with hypertension in the Northeast United States, and it could very well be

the reality, which makes for an encouraging and valuable study. The results yielded from their

study showed that those with hypertension were more likely to have lived in the US for 15 years

or more and were more likely to be overweight or obese among other factors. The fact that those

who have lived in the US for an extended period of time were 1.6 times more likely to have

hypertension than those living in the US for five years or less, alludes to the impact of American

culture and the level of acculturation in Filipino Americans. This phenomenon among Filipino

Americans is something that warrants extensive research, and could develop our understanding

of their unique experiences and beliefs as an ethnic minority. As we will see later, this is a

complex issue with many layers contributing to poor health habits of Filipino Americans. In line

with their conclusion from the first study, Ursua et al. express the need of developing more

effective community-based interventions (2013).

In a study published in 2000 analyzing the prevalence of risk factors of coronary heart

disease in Filipino Americans, Shaw et. al. reported Filipino Americans had a higher incidence

of hypertension compared to Caucasians. As old as this study is, the data they used for analysis

were even older dating back to 1992, which limited their research and revealed the outdated

nature of studies on Filipino Americans. A related study on cardiovascular risk factors in Asian

Americans published in 2009 found that Filipino Americans had a higher prevalence of

hypertension when compared to Whites, even though Asian Americans were generally associated

with lower risk for cardiovascular disease (Ye, Rust, Baltrus, & Daniels, 2009). These studies

further support the need for current research on the disproportionate high prevalence of

hypertension in Filipino Americans, and what kinds of considerations need to made for

evaluating future interventions.


Recognizing the Need for Culturally-tailored Health Interventions

Indeed, there is an overwhelming consensus among the authors cited in this paper of both

a lack of current research on hypertensive Filipino Americans, as well as of the urgent need to

develop culturally-specific health interventions. Subsequently, these issues are of high priority

when studying the health of ethnic minorities. In an article studying the cardiovascular risk

factors in Asian Americans, Ye, Rust, Baltrus, and Daniels (2009) conclude that future

interventions should emphasize the needs of specific Asian American subgroups in addition to

tailoring health programs accordingly. Culturally relevant health strategies are of priority and

cannot be underlined enough for the prevention and control of hypertension and other chronic

illnesses. As stated earlier, the study from Jose, Zhao, Chung, Fortmann, and Palaniappan (2013)

reported a disproportionate prevalence of hypertension among Asian American subgroups, with

Filipino Americans exhibiting the highest rates of hypertension in Northern California. The need

for heterogeneity when studying Asian American subgroups is discernible, further demonstrated

by the finding that the “rates of HTN among Asian American subgroups are unknown largely

due to either underrepresentation or aggregation of Asian American subgroups in epidemiologic

surveys” (pg. 136). It is simply inappropriate to generalize hypertension numbers under the

broad category of Asian Americans. At this point in the literature review, the health disparity that

exists in the Filipino American community became clear. There was an opportunity to explore

the link between integrative health studies and the lack of culturally-relevant interventions for

Filipino Americans and where complementary or alternative modalities like wellness coaching

might be of real benefit.

In her dissertation on the impact of chronic illness in the Filipino family, Manguba

(2012) cites David and writes that “Filipinos may also experience stigma and embarrassment


around the idea of a family member having a chronic illness, as well as the need to avoid shame,

show emotional restraint, and to not disgrace the family name,” making the argument throughout

her paper of how Filipinos specifically deal with illness (pg. 12). For those working with the

Filipino American community, Manguba makes the case for learning culturally appropriate and

supportive ways in communicating with the person about their chronic illness and how it might

impact their family as a whole, which is cultural consideration (2012). In my experience, there

are qualities specific to Filipino Americans that distinguish them from other Asian American

ethnicities. Tuason et al., as cited by Manguba, suggests some reasons for this difference among

other Asian American cultures. One example is that Filipino Americans have a relatively easy

time adapting to the English language. In line with this assertion are the observations of Dr.

Molina who also claims that Filipinos are a unique Asian American ethnicity (Personal

communication, April 8, 2014). Through her extensive research on the complexity of

acculturation among Filipino immigrants, she asserts that prior to moving to the United States,

Filipinos already have some level of American influence as the United States had colonized the

Philippines for over 40 years and the Spanish over 300 years before that. Because of the notion

of Filipino Americans being comfortable with the English language, it is commonly assumed

they are more adept to understanding American culture, which is not the case as Dr. Molina

points out. This is further illustrated Manguba (2012) citing Enrile and Agbayani that “because

of the U.S. influence on the Philippines, there is the notion that Filipino American families are

highly acculturated and this may lead clinicians to suppose that Filipino American families will

have a positive response to mainstream Western methods” (p. 66). The complex multi-

dimensional history of the Philippines and its role in acculturation and health outcomes among

Filipino immigrants reveals the opportunity for further understanding and research in relation to


appropriate health interventions.

In Health Promotion Programs, Fertman and Allensworth (2010) promote the

importance of designing a health promotion program aimed at improving people’s health status.

From the current state of the literature on hypertensive Filipinos, multiple findings suggest it is

crucial that cultural relevance is considered during every step of planning a program. Clearly

stated, “successful customization of programs requires that program staff be aware of and

sensitive to the culture of the program participants as well as incorporate and use culturally

appropriate methods and interventions in the context of the culture” (Fertman & Allensworth, p.

38). Though it is common for researchers on Filipino American health to express the need for

more culturally appropriate health interventions, it is unclear as to what is currently happening

within the existing programs and how future programs are being developed. If more culturally-

sensitive and relevant programs are to be created, considering the level of involvement with

stakeholders and program participants and honoring their personal, cultural, social, and

environmental realities are fundamental for consideration.

Fertman and Allensworth (2010) also indicate that the key to eliminating health

disparities includes four strategies that support program planning, implementation, and

evaluation. These four strategies are: engaging minority groups and communities directly in

addressing health issues; improving cross-cultural staff training; recruiting and mentoring diverse

staff; and addressing root causes of health disparities. Community participation and cultural

tailoring, two factors that Fertman and Allensworth mention are vital when carrying out a

culturally-sensitive health program, were emphasized for the development of an education

program geared towards pre-diabetic Filipino Americans in Hawaii. The purposes of their study

were to culturally tailor a commonly used diabetes prevention education program to Filipino


Americans and to subsequently test its usability by measuring attendance and satisfaction

(Leake, Bermudo, Jacob, Jacob, M., & Inouye, 2011). The findings in this study are certainly

important within the context of my research as it is one of the few reporting the effectiveness of a

specifically adapted health program for Filipino Americans. They reported that 35 of the 40

participants completed all eight classes, which bodes well for future studies implementing

similar strategies. Looking back on how they approached the development of the health classes,

all considerations were details I thought to be pivotal in addressing Filipino Americans, many of

which I will consider in preparing my focus group method. These considerations included an

outdoor neighborhood park located close to two churches with large concentrations of Filipino

Americans parishioners, the flexibility of choosing from two different times on a Sunday,

culturally tailoring the classes based on a cardiovascular disease prevention program that

targeted Filipino Americans, as well as a consideration for self-efficacy whereby each class

ended with participants writing down an objective they wanted to work on for the next class. As

a foundation for their design, they adapted a cardiovascular disease program aimed at Filipino

Americans. The program, entitled “Healthy Heart, Healthy Family,” told the story of Lola, the

term commonly used for grandmother in the Filipino family, and used role-playing to improve

their lifestyles. It was insightful to read about researchers conducting a study specifically on

what I feel is lacking within the body of knowledge and literature on the health of Filipino

Americans, which is a culturally-tailored health intervention, mindful of their participants. The

authors pay great attention to details that really speak to the cultural tailoring of the program.

Effects of Filipinos’ Cultural Beliefs and Perceptions About Illness on Their Health

Understanding the impact of how different cultures and ethnicities view health is one of

the main aims of this paper. Acknowledging the culture, values, traditions, nuances, and history


of Filipino Americans is of great importance in considering how to better understand their needs,

and also necessary in considering new ways of how to go about studying them. It is debatable on

whether or not there are enough appropriate interventions and research that address this issue.

The 2008 study from dela Cruz and Galang mentioned earlier was profound and highly

influential on my research as it addresses and appreciates the complexity and unique

characteristics of the Filipino culture. The researchers found that Filipino Americans generally

attributed the causes of their hypertension to the biomedical model of health. In addition, they

concluded that hypertensive Filipino Americans still have difficulty controlling their blood

pressure regardless of their knowledge regarding treatment. This finding highlights the

underlying question of why Filipino Americans have difficulty controlling their hypertension.

These findings are very useful in tailoring future studies and health education programs and

materials for Filipino Americans. In addition, specific future studies exploring the self-efficacy

of self-care practices among Filipino Americans can also be guided by dela Cruz and Galang’s

study, as they shed light on the background of this population and their history of beliefs and

values around illness. Dela Cruz and Galang’s work is also pertinent as they utilized focus

groups to observe their participants’ views on illness. Consistent with the goals of my study, dela

Cruz and Galang intended for the results of their study to be used in creating culturally-

appropriate programs for Filipino Americans for the purposes of improving management of their

blood pressure. It is my hope that the qualitative results my study produces will be able to be

evaluated and compared alongside to dela Cruz and Galang’s focus group study, adding to the

literature on hypertensive Filipino Americans.

Further highlighting the importance of culture, traditions, values, and experiences unique

to Filipino Americans, Manguba (2012) points out that the level of acculturation, cultural values,


religious influence, and language barriers may play a significant role in how they view health

and their process in seeking out help. The focus of Manguba’s research was further educating

professionals on Filipino culture and the influence it may have on how Filipinos cope with a

family member who is chronically ill. By having basic knowledge of ethnic identity and cultural

values, healthcare providers and educators will have a better understanding of their patients’

needs. As Manguba goes in depth into the background and history of Filipinos, she reveals the

complexity of their experience on a cultural and traditional level, underlined by the viewpoint

that Filipinos in the United States still experience forms of ethnic and culturally-related

oppression that may have originated in the Philippines (David, as cited in Manguba, 2012). One

factor that could play a role in the poor management of their blood pressure is the worldview and

coping styles that Filipino Americans have. A passive approach coupled with accepting one’s

situation, as well as the tendency for positive reframing as opposed to confronting a problem

stems from an Eastern perspective (Bjorck, as cited in Manguba, 2012). Manguba includes this

evidence to support her view that ethnic minorities may feel a higher level of vulnerability and

be more passive in the way they handle a stressful situation. Although positive reframing and

choosing to be passive under stressful situations was considered in light of coping styles, this

concept could offer insight to the experiences of hypertensive Filipino Americans who

experience high levels of stress. To further illustrate values and customs unique to the Filipino

culture, Manguba cites Patacsil when explaining how family relationships are preserved,

defining the concepts of utang na loob, hiya, amor propio, and pakikisama. Patacsil’s definitions

are profound, and when loosely translated, utang na loob means having an obligation to pay

one’s parents back for their sacrifices, hiya is dishonor or humiliation, amor proprio means

having respect for one’s self, and pakikisama is how well one gets along with others (2012). The


scholarship and research of Manguba in explaining Filipino culture and the many factors to

consider for chronic illness within the Filipino family is of great importance. Though her study

was published only two years ago, she too expressed a lack of studies on Filipinos, echoing the

viewpoints in the articles within this literature review.

A Different Approach to Managing Hypertension

From the current academic literature on hypertensive Filipino Americans, it seems as if

the research and its discussions have reached a plateau. The obvious need for more culturally

sensitive interventions particularly in a population where the health condition is prevalent and

disproportionate, and the alarming question of why no studies spanning the past 25 years show

any kind of significant improvement motivated further research efforts. The majority of the

articles reviewed on Filipino American health did not have any concrete answer of how to go

about addressing effective treatment issues for conditions like hypertension. One of my expert

interviews was with Dr. Cricel Molina to whom I referred earlier. When I spoke with her about

this issue she acknowledged my claims and reaffirmed the lack of studies available on Filipino

Americans and the specific cultural experiences they have. Additionally, she asserts that

“research is very lacking on figuring out what cultural influences and factors are, when dealing

with health and wellness among Filipino Americans” (Personal communication, April 8, 2014).

Dr. Molina’s passion and expertise on studying the experiences of Filipino immigrants is one

such effort in contributing to this field.

What is the pivotal gap in knowledge that has not been explored yet? While it has been

commonly stated that there is a lack of culturally-appropriate health programs, the issue of blood

pressure management has not been thoroughly addressed. The existing studies published on the

the prevalence of hypertension in Filipino Americans present an opportunity for additional


research from a different angle. As stated earlier, this issue begs the question of getting to the

root of how Filipino Americans view their health condition, and understanding their perspectives

and behaviors on treatment, both positive and negative. Wellness coaching is a modality and tool

that has proven to be powerful and many times life-changing. Though it has not been heavily

studied, exploring the feasibility of wellness coaching for Filipino Americans with hypertension

could be worthwhile.

In health and wellness coaching, the role of the coach is to support their client with

whatever goals they want to set with the aim of improving their lives. The coach is an ally at

every step of the coaching process, and one of the main tools he or she uses is to ask questions

that elicit responses or questions from the client that have to do with self-inquiry. When health

coaching is applied for chronic illness self-management, Howard and Ceci (2012) indicate that it

is different “from traditional models of health education because of the interactional dynamics

between nurse and patient, and an orientation to care that ostensibly centres and empowers

patients” (pg. 223). What’s more, renowned wellness coach and wellness professional Dr.

Michael Arloski (2007) claims that the majority of wellness and wellness promotion is tailored

with the mindset that providing people with the best possible information for their health

condition will lead to improvement in health. Dr. Arloski’s view implying that delivering health

education to people does not suffice in a positive health outcome is both admirable and bold.

While there is no doubt that accurate and culturally sensitive health information is important,

many times there is still no action towards behavior change in a client. This is where the wellness

coach’s role becomes crucial for the benefit of the person with whom he or she is working.

In a relevant article evaluating a pilot study that was a culturally-tailored health coaching

program for Chinese Americans with type 2 diabetes, Ivey et al. (2012) found that health coaches


may improve medical outcomes for the underserved. This particular research combined both

culturally tailoring a health program, and the use of health coaching, strengthening my stance on

the impact of these two factors. Their pilot study is of great significance to my research as it

bridges the gap of using a culturally tailored CAIM modality such as health coaching, with

success in managing blood glucose levels of Chinese Americans with type 2 diabetes. Their

design included using the Bodenheimer model in which health coaches are positioned to have

pre- and post-visit meetings with patients, maintain communication with patients between

doctor's visits, in addition to assisting the doctor with daily tasks. Another component of this

study I found to be important was the fact that a doctor, health coach, and registered dietitian

were working alongside one another in a professional setting. Communication between three

different providers is promising for the field of integrative health as it allows interaction and the

need to communicate effectively for the patient. Also worth noting is that the health coaches

were medical assistants who received health coaching training sessions. The authors express that

the sustainability of having health coaches in this setting could be costly if they were to add

additional coaches, as they are not usually reimbursed by health insurance plans. Combined with

the outcomes of the culturally-tailored diabetes education program for Filipino Americans from

Leake, Bermudo, Jacob, Jacob, M., and Inouye (2011), this study focusing on health coaching

for Chinese Americans raises the possibility of applying it to the Filipino American population.

Summary and Conclusion

The literature reviewed above, as well as interviews conducted, reveal the current health

status of hypertensive Filipino Americans and the lack of studies available. It is still uncertain as

to which types of literature, biomedical or complementary and alternative, or both, should be

examined further for understanding the health disparity among Filipino Americans. Perhaps a


comprehensive survey or extensive meta analysis would be helpful in organizing the current

research available. This study could include the history and experiences of Filipino immigrants,

acculturation experiences, the stories of Filipino immigrants varying in age, and the relationship

between first and second generation Filipino Americans to name a few. Currently, we know

many risk factors that account for causing hypertension among this population, but why they are

unable to control their blood pressure successfully has yet to be studied in depth.

The high prevalence of hypertension among Filipino Americans when compared to other

Asian Americans and Caucasians was documented in a few key articles that were examined for

common themes. This phenomenon was mainly supported by research analyzing awareness,

treatment, and control of high blood pressure in two separate studies conducted over 25 years

apart. Stavig, Igra, and Leonard (1988), Ursua et al. (2013), and many other scholars studying

Filipino Americans all agree on the lack of current research available related to hypertension

control. Research concerning the need for additional culturally sensitive health interventions was

presented in light of the lack of heterogeneity in studying Asian Americans. The studies from

Shaw et. al. (2000) and Ye, Rust, Baltrus, & Daniels (2009) further highlighted the

disproportionate incidence of hypertension when compared to other Asian ethnicities and

Caucasians. This research has shown that Filipino Americans have a high prevalence of

hypertension compared to other Asian subgroups.

Dr. Arloski’s work with wellness coaching presented a different way of approaching how

to work with this population. The article by Ivey et al. (2012 reported on the success of a

culturally-tailored coaching program could have on Chinese Americans with diabetes. Their

study combined coaching and culturally tailoring a health intervention, providing evidence for

application in other ethnic minority populations.


The purpose of this modified thesis is to address the issue of how to better understand

what hypertensive Filipino Americans need for successful blood pressure control. Focus groups

will be used in exploring what these needs are, in the hopes of improving our understanding of

their experiences on a cultural and behavioral level.

Methodology

With the purpose of understanding how to better address the needs of Filipino Americans

with hypertension, focus groups will be used to gain perspective on the participants’ views and

experiences around hypertension management. The focus group method was chosen because the

intimate group setting lends itself to sharing experiences without a power dynamic that is usually

present in a setting with an authority figure, which might otherwise influence the participants’

interactions. The dynamic group setting within each focus group hopes to elicit common themes

and use of words or terms that might give insight to the group’s perceptions around controlling

and trying to improve blood pressure management (Fertman & Allentown, 2010).

Additionally, participants will be able to talk about the questions and prompts given to

them in the language in which they naturally feel comfortable conversing. The hybrid slang of

“Taglish,” which combines the Tagalog and English languages is common for Filipinos to use in

daily conversation. It is my hope that the participants will be comfortable in using Tagalog,

English, Taglish, or any other dialect they are native in, within the focus group setting.

Participants and Location

Participants will be recruited through convenience sampling in the East San Jose area.

Flyers, posters, and announcements printed in both Tagalog and English will be posted in

locations that large concentrations of Filipino Americans frequent the most. These sites include

hospitals, churches, health clinics, care homes, grocery stores, and community centers within a


15 mile radius from St. Francis of Assisi church. Of the 600,000 Catholics in the San Jose

diocese, roughly 76,000 are Filipino Catholics (Chen & Jeung, 2012). From personal experience

during my time in middle school, the number of churches I attended with my family always had

large numbers of Filipinos in attendance. In particular, St. Francis of Assisi church, as with

multiple churches throughout San Jose, has a large concentration of Filipino American

parishioners. Additionally, the various public settings chosen are aimed at recruiting a mixture of

participants.

Inclusion criteria during recruitment include past physician diagnosis of hypertension,

antihypertensive medication useage, high blood pressure readings, ability to speak and

understand Tagalog and English or other Philippine dialect, and will be decided by phone

interviews prior to arranging the focus groups. It is also during the phone interviews where

informed consent will be obtained from the potential participants, explaining the research and

procedures involved with the process.

At least a total of 30 participants will be recruited. The focus groups will consist of six to

eight participants per group, but eight to ten participants will be invited to account for

participants who might not attend. One group will have all women, another group will contain all

men, and the third group will consist of mixed gender.

Procedure

The study will be spread out over three different focus group sessions. The focus groups

will be held will be at a community center with plenty of parking available, located within 15

miles of St. Francis of Assisi church. For participants taking public transit, fares will be

reimbursed. Participants will be asked to arrive at 9AM for check in, and the focus groups will

start at 10AM sharp. The focus groups will last two hours. There will be two facilitators


including myself, on hand to moderate and conduct the focus groups. The second facilitator will

be in charge of audio recording, observing non-verbal communication such as body language and

facial expressions, as well as note taking when needed. I will be administering the prompts and

will be responsible for keeping the participants engaged with the questions keeping the pace

smooth throughout. Both facilitators will be bi-lingual, able to both speak and understand

English and Tagalog, in addition to having interest in Filipino health and previous research

experience with Filipino Americans or other ethnic minorities. Both facilitators will be focused,

observant, and mindful of participants needing a short break or quick stretch to prevent a lull in

the discussion. The facilitators will both engage in a grounding exercise to establish focus and

presence prior to the start of the focus group.

All three focus groups will have the same setting, be asked the same questions, and will

have the same moderator and observer. At the end of the third focus group, the data from all

three sessions will be analyzed to see if saturation has occurred, at which point it will be decided

whether or not additional focus groups will be required.

Participants will fill out a questionnaire to establish baseline for point of comparison and

organizing data, prior to the start of the focus groups. The questionnaires will be helpful in

tracking the identification of participants when organizing the data, allowing for detailed analysis

and comparison. The background questionnaire is based on the questions dela Cruz and Galang

(2008) used for their baseline questionnaire. The questionnaire will ask for name, gender, age,

zipcode, primary and secondary language, marital status, work status, occupation, income, living

situation, food preference, length of time lived in the United States, and if they identify as first or

second generation Filipino American, religious or spiritual affiliation, when they were diagnosed

with hypertension, if they are currently on antihypertensive medication or any other treatment,


any comorbidities and other chronic illnesses, alcohol intake, whether or not they smoke, and use

of recreational drugs.

Simultaneous to completing the questionnaire, participants will be asked to fill out an

informed consent form and a non-disclosure form that stating all information on the

questionnaire and within the focus group session will be kept confidential. In addition, it will be

stated prior to the start of the focus group that their participation is voluntary and they are

allowed to dismiss themselves if they feel the need to do so.

The questions given to the participants are aimed to elicit responses about their

experiences related to the management of their hypertension and will be evaluated by a focus

group expert and a health coach familiar with qualitative studies. Questions were modeled on the

questions used by dela Cruz and Galang in their focus group study, suggested by Kleinman et al.,

but will be tailored specifically around self awareness and wellness coaching values (Kleinman

et al., as cited in dela Cruz & Galang, 2008). The moderator will start out by thanking the

participants for their time and willingness to learn more about their health and the experiences of

others with hypertension. Before the first question, if they are comfortable, participants will be

asked to participate in an ice breaker geared towards establishing a positive energy in the room.

Participants will be asked to pair up and share something fun they like to do with one another.

After a few minutes, the group will come back together and share what they found out about

their partner with the hopes of getting everyone comfortable talking amongst each other in the

group setting.

The first question will be general and move to specific topics related to hypertension.

There will be a projection screen showing the questions in English and Tagalog, as well as the

moderators being available for translating the questions or prompts.


Focus group questions

Hypertension Experience Questions

● How does your hypertension affect your daily living? (Prompts - Do you feel heavily

affected by it? / Does it affect your work, school, home, diet, relationships, leisure time?)

● How comfortable are you about your knowledge about hypertension?

● When you see a medical provider, do you prefer male or female provider? Filipino or

non-Filipino? Please elaborate on why.

● In what ways do you feel that your healthcare provider is able to help you?

● Where does your main source of health information come from? (Prompts - Internet,

doctor, doctor’s office, family/ friends, TV, radio, other) Do you feel that these sources

are adequate in providing you with enough information for managing your hypertension?

How would you change this information so that it could best serve you?

● What does a positive experience look like during a visit with your healthcare provider?

● Whether or not you are on antihypertensive medication, please describe ways that you

feel like you are able manage your high blood pressure effectively. How do you know it

works? (Prompts - do you feel like these ways compliment your medication? / Are these

interventions successful for you?)

● Describe your experience of when you feel you have the least control of your

hypertension (What does it feel like and what do you feel is causing it?)

● How do you feel food and your eating habits affect your blood pressure? (Prompts -

preference of Filipino food vs American food, or both?) What do you feel like would help

in improving your food eating habits? (Prompts - recommendations from doctor, nurse,

health provider, friends and family, community-based health events, etc)


● Who is the primary person(s) you rely on when you are worried about your health? Your

spouse, family member, doctor, etc… How do these people support you?

● Does spirituality or religion play a factor in how you manage your hypertension? (If so,

can you please elaborate or give an example?)

● How does time management and scheduling your obligations affect your blood pressure?

“What Would it Look Like” Questions

● If there was a program or resource directed at helping you manage your hypertension,

and you had the chance to attend it tomorrow, what kinds of things would attract/ make

you want to go? What would this program look like? (Prompts - location, language

options, cost, content)

● What would it look like if you had a fun exercise routine or activity that helped for your

blood pressure? (Prompts - by yourself, with a friend or family member, in a group, walk

in the park, etc)

● If you had to name the top one or two barriers that are in the way of lifestyle

improvements (i.e. communication, information/ knowledge about hypertension, diet,

exercise, stress management), what would they be? (Prompts - what makes it difficult for

you to eat better, exercise more, or take your medication as prescribed?)

● What is something new that you learned about yourself as you have been living with

hypertension? How does this make you feel?

Analysis

The audio recordings will be transcribed verbatim and will be analyzed for common

themes. Both moderators will read transcriptions separately and then compare analysis. The

handwritten notes taken during the sessions will also be analyzed separately and then compared


between moderators. Constant comparative analysis will be used to generate these common

themes around body language and non-verbal communications, which questions participants

became excited, angry or nervous about, which questions participants were resistant in

answering, and during which questions the participants needed translations. In addition to the

baseline information obtained from the questionnaire, the questions used in the focus groups will

be used as preliminary categories for organizing information. A matrix of the responses will be

created, allowing for comparisons among the three focus groups (Mullaly-Quijas, Ward, &

Woelfl as cited in dela Cruz & Galang, 2008). This matrix technique will be used to examine the

redundancy, suggesting data saturation among the responses (Krueger as cited in dela Cruz &

Galang, 2008). The coaching questions will be highlighted within the matrix as they are a

significant component of the study.

Potential Outcomes and Implications of Research

Given the fact that there has been little research on why hypertension management has

not improved in Filipino Americans, it is uncertain as to what kinds of findings this qualitative

study will yield. While that may be the case, the focus groups will potentially reveal further

evidence about the barriers and obstacles the participants face when managing their blood

pressure and overall health. It is likely that the impact of cultural values and issues associated

with behavioral change will be observed not directly from the questions themselves, but perhaps

from the conversation and discussion from the group setting. Traditionally, Filipinos come from

a collectivist culture where they look to family and community for support in times of stress

(Manguba, 2012). The use of focus groups and utilizing the group setting format is proposed for

this reason. The dialogue from the group discussions will be pivotal to observe as they will likely

uncover the nuances and challenges that participants encounter.


An important part of the discussions within the focus groups will be asking the prompts

or probing questions that will get the participants to elaborate on their difficulties in controlling

their hypertension. The nature of their responses as to what preferences they have for their

healthcare provider and the type of health information they prefer will likely provide insight for

considering how to effectively address their healthcare experience. Furthermore, observing

which focus group questions bring about excitement, resistance, anxiousness and anger from the

participants will be important for tailoring and evaluating future studies. Noting whether those

questions fall under the specific hypertensive or coaching categories will also be valuable in

seeing how the wellness coaching perspective can be applied.

Because Filipino Americans have been shown to attribute the causes of hypertension to

external factors such as poor dietary choices and lack of exercise, it is possible they will express

resistance or ambivalence when posed with the questions tailored from the wellness coaching

approach. These questions included: “What would it look like if tomorrow you woke up, and

those barriers were gone?” and “If there was a program or resource directed at helping you

manage your hypertension, and you had the chance to attend it tomorrow, what kinds of things

would attract/ make you want to go? What would this program look like?” Participants may take

some time in answering them, as they are not typical questions. It is also likely that the phrasing

or structuring of the questions may need translation for participants who have trouble

understanding the questions. Noting how the questions need to be tailored for the participants

will be valuable for future research and culturally-tailored interventions. In the interview with the

Mabuhay Health Center, Villanueva and Chinn mention the health coach as a beneficial

component of their services, indicating progress for the health of their patients which bodes well

for future integrative health strategies among Asian Americans (B. Villaneuva & T. Chinn,


personal communication, 2014). The implications from this research can also be useful in

evaluating the Mabuhay Health Center’s current health coaching program and possibly offer

some suggestions.

It is also likely that the participants will express how their dietary habits and exercise

routines positively and negatively affect their hypertension, similar to findings from reported

from dela Cruz and Galang (2008). Observing the dialogue shared by the participants will be

important to offering new insights about how the topics of food and exercise can be tailored in a

culturally-appropriate and sensitive way.

The implications from this study can also provide a foundation for future dissertation

research. As the literature review in this paper has shown, there is a need for additional studies to

better understand the experiences of Filipino Americans and their health. Through the literature

review and expert interviews, it is apparent that there is still much to be learned, and that

opportunities for studying Filipino American health are encouraged. The interviews revealed the

different contexts that Filipino Americans can be studied in, illustrating the complexity of their

experiences in managing their health. It is also possible to review and evaluate this modified

thesis to see if the methodology is applicable to studying Filipino Americans with chronic

illnesses such as diabetes or cardiovascular disease. Furthermore, additional complementary or

alternative healing modalities could be explored to measure effectiveness in coping and

managing an illness for ethnic minorities. These additional studies can only improve our

understanding of Filipino Americans and their wide range of experiences with issues such as:

immigration and acculturation and its effects on lifestyle and health; understanding the

relationship between first generation and second generation Filipino Americans and it’s impact

on the health of the family; measuring the effectiveness of a culturally-tailored wellness


coaching model as a supplement or stand-alone intervention for a chronic illness; and

understanding the lives of elder Filipino Americans to address their specific needs. As pointed

out earlier, Filipino Americans constitute almost half of the Asian American population in

California. If the available literature and current researchers agree on the lack of studies on this

population, there is an imperative need for continuing to better understand how to address their

health.

Limitations and Ethical Considerations

The small size of this study limits its generalizability. The experiences and discussion

within the focus groups will be unique to those participants, which may be harder to translate to

the broader Filipino American community. This study did not factor in those Filipino Americans

who might not frequent the locations of the recruitment sites, including those in the underserved

population. Additional studies are needed to examine the Filipino American population that is

underserved. In addition, recruitment criteria and convenience sampling methods did not account

for heterogeneity among the participants. Although participants had to note whether they

identified as first or second generation Filipino Americans, the focus groups were not selective

of one or the other. This research simply studied the participants that were available and

interested in the study. Moreover, the health trends of second generation Filipino Americans

were not accounted for in this study. Though it is unknown as to how many second generation

participants will be involved with the study, considering their health behaviors would be helpful

in tailoring the focus group questions and the possibility of conducting a focus group of all

second generation Filipino Americans. There is a lack of current statistics and in-depth studies

on the health status of second generation Filipino Americans.

While the focus group method has been used in other health studies researching Filipino


Americans, the questions used for this particular focus group study have not been validated. This

study may be one of the first in proposing questions tailored from the wellness coaching

philosophy. Because of the nature of focus groups and location of participants relative to each

other, there is a possibility of participants disclosing confidential or sensitive material outside of

the study’s location. This can pose a problem if participants happen to live in the same

communities or social circles as one another.

Discussion

This modified thesis proposes the use of focus groups to further investigate and improve

our understanding for how Filipino Americans with hypertension currently manage their

condition. Exploring the landscape of Filipino Americans in academic literature has been eye-

opening, informative, and humbling. The current literature highlights the lack of research and

data needed to effectively address Filipino American health, and in particular, the

disproportionate prevalence of hypertension among Asian Americans.

As illustrated in the literature review, the current studies report no significant

improvements in hypertension rates among Filipino Americans in the past several years.

Although dela Cruz and Galang’s (2008) study provide valuable evidence that Filipinos associate

stress, poor diet, and lack of exercise as the main causes of their hypertension, there have been

few studies that focus on health interventions that have proven effective for long-term behavior

change. It is also suggested that Filipino Americans’ emphasis for bodily awareness can be used

as a guideline in improving the management of chronic illness (Becker, 2003). This point can be

explored further in future studies. The dialogue in the expert interviews revealed the different

contexts that Filipino Americans can be studied in, thus illustrating the complexity of their

experience living in America and maintaining their health. It is worthwhile to consider


approaching this issue from an integrative health perspective, accounting for all aspects of one’s

life including lifestyle and behavior change.

One such approach would be researching the feasibility of a health promotion program

developed from models suggested by Fertman and Allentown (2010) as an alternative or

supplement to current treatment plans of hypertension. Tailoring these health programs would

consider cultural-sensitivity, the context in which the program is being planned for, and

engagement of all stakeholders involved during each step of planning (Fertman & Allensworth,

pg. 38, 2010). The study on creating a culturally-tailored lifestyle intervention program for

Filipino Americans is evidence that these types of health promotion programs are being

evaluated and implemented with success (Leake, Bermudo, Jacob, Jacob, M., & Inouye, 2011).

Involving the participants of the programs as well as all stakeholders involved are key to

communication. Additionally, language and cultural values, and considering the contexts in

which health programs are created are important at the very beginning of program planning.

Another approach in addressing the lack of blood pressure control in Filipino Americans

would be the use of wellness coaching as mentioned earlier. Because hypertension is a often

considered a modifiable disease, considering wellness coaching as an intervention for improving

behavior modification is relevant. My interview with Dr. Molina encouraged the exploration and

cultural tailoring of a wellness coaching program, suggesting its strengths and the effectiveness it

could have on Filipino Americans (Personal communication, April 8, 2013). Drawing from Dr.

Arloski’s (2009) work on how wellness coaching is different from other types of coaching and

medical interventions, developing a pilot wellness coaching program from the findings of this

modified thesis would be the next step. The implications from my focus group study would be

evaluated and considered in developing this pilot program.


Both Dr. Molina and the anonymous researcher agreed that there is very few research

examining the needs of Filipino Americans. Additionally, the complex history of Filipinos and

their migration experiences to the United States have been shown to play a role in their

acculturation and subsequent stress levels. When looking at Asian Americans as a whole, these

cultural experiences are unique to Filipinos and how they manage their lives in America. Gaining

a better understanding of these experiences that Filipino Americans experience will help inform

the development of health programs and education materials.

The experience of interviewing different researchers and the people who work directly

with Filipino Americans was invaluable. The information and perspective gained from the expert

interviews revealed opportunities for conducting more research on a number of topics concerning

Filipino Americans. The anonymous researcher I interviewed insisted on the importance of

looking at stress when studying hypertensive Filipino Americans. Once this researcher started to

elaborate on the many different types of stress that they experience, it was clear that the topic

was rich of experiences and stories that have yet to be studied in the context of health.

Villaneuva also shared her views on how stressful the experience of immigrating to the United

States can be, affecting the health of both first and second generation Filipino Americans in

different ways (Personal communication, April 12, 2014). Conducting research on the impact

stress has on the health of first and second generation Filipino Americans would also be of great

value in helping us to understand and address their needs.

Summary

Though research shows that Filipino Americans are aware of their hypertension and are

knowledgeable about treatment, why they are unsuccessful at managing their blood pressure is

still unclear. The need for culturally-tailored health programs proposed by the articles in the


literature review is apparent, yet we still do not know what these interventions look like. The

research, information, and interviews offered in this modified thesis are just beginning of

studying the health of Filipino Americans from an integrative health perspective. As stated

earlier in the paper, the hopes of this research on a larger scale is to produce findings that can be

evaluated as potential guidelines for tailoring health interventions than can be applied to all

ethnic minorities struggling with a serious health condition. Furthermore, if the opportunity were

to present itself, I am encouraged to carry out this research and continue to understand the health

of Filipino Americans on a deeper level.

Interviews with experienced researchers and community members working directly with

Filipino Americans further underlined the complex nature of studying this population. Having

the chance to engage with these Filipino scholars and researchers was truly encouraging and

informative of the nature of current research. The focus group method proposed in this paper

hopes to reveal ways in which we can go about developing these health interventions. This paper

serves as a starting point for future researchers and colleagues interested in studying ethnic

minorities with a chronic health condition.

The literature review revealing the lack of studies and current research available was

pivotal in distinguishing the kinds of future research that should be considered when trying to

understand the barriers to controlling hypertension. Furthermore, the importance and urgency of

studying the experiences that second generation Filipino Americans have with their health

emerged from this paper. Currently there are no in-depth studies focused on the health trends in

this demographic. This health disparity needs to be addressed if we are to improve the health of

future Filipino Americans.

Although there are only a few researchers focusing on the needs of the health of Filipino


Americans, they do exist. Articles presented in this paper highlighted the success of culturally-

tailored health coaching and health promotion programs, strengthening the argument of a pilot

wellness coaching program. The fundamental idea of using self-empowerment as a tool for

managing a condition such as hypertension as it pertains to Filipino Americans, is something that

has yet to be explored thoroughly. Dr. Arloski writes that with wellness coaching, the client is

seen as a whole person and accepts them for who they are, ready to make a change in their life

(2007). It is time for us to cultivate the vibrant health present in all Filipino Americans and

encourage our communities to support and raise awareness around additional research efforts.


Bibliography

Asian American Populations (2013). Office of Minority Health & Health Equity. Retrieved from

http://www.cdc.gov/minorityhealth/populations/REMP/asian.html

Arloski, M. (2009). Wellness coaching for lasting lifestyle change. (p. 39). Duluth, MN: Whole

Person Associates, Inc.

Becker, G. (2003). Cultural expressions of bodily awareness among chronically ill Filipino

Americans. Annals Of Family Medicine, 1(2), 113-118. Retrieved from

http://annfammed.webliv.us/content/1/2/113.short. doi: 10.1370/afm.39

Chen, C., & Jeung, R. (2012). Sustaining faith traditions: Race, ethnicity, and religion

among the latino and asian american second generation. (p. 167). New York, NY. New

York University Press.

dela Cruz, F.A. & Galang, Carmen B. (2008). The illness beliefs, perceptions, and practices of

filipino americans with hypertension. Journal of the American Academy of Nurse

Practitioners, 20(3), 118-27. Retrieved from

http://search.proquest.com/docview/212892169?accountid=25260

Fertman, C. I., & Allensworth, D. D. (2010). Health promotion programs: From theory

to practice. San Francisco, CA: Jossey-Bass: A Wiley Imprint.

Gong, F., Gage, S. L., & Tactata, L. A. (2003). Helpseeking behavior among Filipino

Americans: A cultural analysis of face and language. Journal of Community Psychology,

31(5), 469-488. Retrieved from

http://mq6ld7jp9v.search.serialssolutions.com/?sid=Refworks&charset=utf-

8&__char_set=utf8&genre=article&aulast=Gong, FangGage, Sue-Je L.Tacata,Leonardo

A.Jr.&auinit=Leonardo A.Jr.&title=Journal of community


psychology&stitle=J.Community Psychol.&date=2003&volume=31&pages=469-

488&issue=5&issn=00904392&atitle=Helpseeking behavior among Filipino Americans:

A cultural analysis of face and language&spage=469&au=Gong, FangGage, Sue-Je

L.Tacata,Leonardo A.Jr. &

Howard, L. M., & Ceci, C. (2012). Problematizing health coaching for chronic illness

self-management. Nursing Inquiry, 20(3), 223-231. doi: 10.1111/nin.12004

Huang, B., Appel, H.B., Nicdao, E.G., Lee, H. J.D., & Ai, A.L. (2012). Chronic

conditions, behavioral health, and use of health services among asian american men: The

first nationally representative sample. American Journal of Men's Health, 7(1), 66-76.

doi: doi: 10.1177/1557988312460885

Ivey, S. L., Tseng, W., Kurtovich, E., Lui, B., Weir, R. C., Liu, J. ...Hubbard, A. (2012).

Evaluating a culturally and linguistically competent health coach intervention for

chinese-american patients with diabetes. Diabetes Spectrum, 25(2), 93-102. Retrieved

from

http://resources.ciis.edu:2048/login?url=http://resources.ciis.edu:2095/docview/10212438

85?accountid=25260

Jose, P., Zhao, B., Chung, S., Fortmann, S., & Palaniappan, L. (2013). PS1-46: Variation in

Hypertension Prevalence Among Asian American Subgroups: Results from PACS (Pan

Asian Cohort Study). Clinical Medicine & Research, 11(3), 136.

doi:10.3121/cmr.2013.1176.ps1-46

Ko, C. M., Sadler, G. R., Ryujin, L., & Dong, A. (2003). Filipina american women's

breast cancer knowledge, attitudes, and screening behaviors. BMC Public Health, 3(27),

doi: 10.1186/1471-2458-3-27


Leake, A. R., Bermudo, V. C., Jacob, J., Jacob, M. R., & Inouye, J. (2011). Health is wealth:

Methods to improve attendance in a lifestyle intervention for a largely immigrant filipino-

american sample. J Immigrant Minority Health, 14 (3), 475-480. doi: DOI

10.1007/s10903-011-9487-0

Manguba, C. A. (2012). The impact of chronic illness on a filipino family. (Doctoral

dissertation, Alliant International University), Available from ProQuest Dissertations &

Theses Full Text. (902746084). Retrieved from

http://resources.ciis.edu:2048/login?url=http://resources.ciis.edu:2095/docview/90274608

4?accountid=25260

Molina, L. C. (2012). A qualitative exploration of the effect of age at migration on the

acculturative processes of filipino immigrants: Implications for public health studies.

(Doctoral dissertation), Available from UCLA Electronic Theses and Dissertations.

Retrieved from http://escholarship.org/uc/item/09t9b4g1

Nwankwo, T., Yoon, S.S., Burt, V., Gu, Q. (2013). Hypertension among adults in the United

States: National Health and Nutrition Examination Survey, 2011–2012. NCHS Data

Brief, (133). Retrieved from http://www.cdc.gov/nchs/data/databriefs/db133.pdf.

Prochaska, J., Norcross, J., & Diclemente, C. (1994). Changing for good. New York:

Avon Books, Inc.

Ryan, C., Shaw, R., Pliam, M., Zapolanski, A., Murphy, M., Valle, H., & Myler, R. (2000).

Coronary heart disease in Filipino and Filipino-American patients: prevalence of risk

factors and outcomes of treatment. The Journal Of Invasive Cardiology, 12(3), 134-139.

Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10731280

Stavig, G. R., Igra, A., & Leonard, A. R. (1988). Hypertension and related health issues


among asians and pacific islanders in california. Public Health Reports, 103(1), 28-37.

Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1477940/

Ursua, R., Islam, N., Aguilar, D., Wyatt, L., Tandon, S.D., Abesamis-Mendoza, N., …Trinh-

Shevrin, C. (2013). Predictors of hypertension among filipino immigrants in the northeast

us. Journal of Community Health, 38(5), 847-855. doi: 10.1007/s10900-013-9689-6.

Retrieved from http://link.springer.com/article/10.1007/s10900-013-9689-6#close. doi:

10.1007/s10900-013-9689-6

Ursua, 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. doi:

http://resources.ciis.edu:2261/10.1007/s11606-013-2629-4

Ye, J., Rust, G., Baltrus, P., & Daniels, E. (2009). Cardiovascular risk factors among Asian

Americans: results from a National Health Survey. Annals Of Epidemiology, 19(10), 718-

723. doi:10.1016/j.annepidem.2009.03.022. Retrieved from

http://www.annalsofepidemiology.org/article/S1047-2797(09)00117-3/abstract


Appendix A

“What Would it Look Like Questions” Translated in Tagalog

● If there was a program or resource directed at helping you manage your hypertension,

and you had the chance to attend it tomorrow, what kinds of things would attract/ make

you want to go? What would this program look like? (Prompts - location, language

options, cost, content)

● Kung merong mga programa o pagsasama sama na magtuturo sa iyo kung paano ayusin

ang iyong mataas na presyon ng dugo at pwede kang makakuha ng mga impormasyon

bukas, ano-anong mga bagay ang mga gusto mong malaman at magtutualk sa iyong

pumunta? Magiging dahilan ba ng hindi mo pagpunta ang bayad, kung tagalog ang

meeting, ang lugar at kung ano ang ituturo?

● What would it look like if you had a fun exercise routine or activity that helped for your

blood pressure? (Prompts - by yourself, with a friend or family member, in a group, walk

in the park, etc)

● Anong klaseng exercise o ehersisyo ang nakatulong sa hindi pagtaas ng presyon mo?

Mas madali bang gawin ang mga actibidad na ito ng mag isa, o may kasama?

● Are you open to trying new ways of managing your condition? Is there something you

have been wanting to try? (Prompts - Are you familiar with coaching? Specifically health

or wellness coaching?)

● Gusto mo bang sumubok ng ibang paraan kung paano maco-control ang iyong

condition? Meron ka bang matagal ng gustong subukan, tulad ng personal na coach

para sa kalusugan?

● If you had to name the top one or two barriers that are in the way of lifestyle


improvements (i.e. communication, information/ knowledge about hypertension, diet,

exercise, stress management), what would they be? (Prompts - what makes it difficult for

you to eat better, exercise more, or take your medication as prescribed?)

● Ano ang pumipigil sa iyo para mapabuti ang kalagayan ng iyong kalusugan?

Kakulangan ba sa information, pag di dieta, stress, pag e exercise? Mas mahirap bang

kumain ng tama, or mag exercise kaya mas pinipili na lang uminom ng gamot?

● What is something new that you learned about yourself as you have been living with

hypertension? How does this make you feel?

● May natutunan ka ba tungkol sa saril mo simula ng malaman mong mataas ang presyon

ng dugo mo? Ano ang nararamdaman mo tungkol sa kondisyon mo?

(Translated by Jeline Gonzaga)

understanding the needs of hypertensive filipino … · filipino americans have quickly become one...

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