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Education by mail is as effective as in-class training for Korean-Americans with high blood pressure

Competing life priorities and limited resources often prevent first-generation Korean-American immigrants, who suffer from high rates of high blood pressure (BP), from attending health-promotion classes. Miyong T. Kim, R.N., Ph.D., of the Johns Hopkins University School of Nursing, and colleagues recruited adults from the Baltimore/Washington Korean-American community to study effective ways to improve their BP self-management.

The good news is that education by mail may be as effective as an in-class education for teaching this group to manage their high BP. The researchers involved the community in planning the study and in recruiting the participants from Korean churches, grocery stores, and local Korean language publications. Study participants were all first-generation Korean-Americans, ages 40-65 years, who had systolic BP of at least 140 mm Hg and/or diastolic BP of at least 90 mm Hg, or were taking BP medications.

Participants completed a baseline questionnaire and were assigned to either the in-class education group (184) or the mail education group (261). The two interventions included education about blood pressure, its control, and reducing risk factors, such as avoiding high-salt diet and smoking. Each intervention also introduced and enhanced strategies for managing BP, addressed immigrant-related adversities in the participants' lives, and promoted self-care behaviors for control of high BP.

At baseline, the mean systolic BP was 142 mm Hg for the in-class group and 144 mm Hg for the mail group, with mean diastolic pressures of 90 and 92 mm Hg, respectively. At 3 months after the beginning of each intervention, the mean reduction in systolic BP was 13 mm Hg for the in-class group and 16 mm Hg for the mail group; mean diastolic BP decreased by 10 mm Hg for the in-class group and 11 mm Hg for the mail group.

The proportion of participants with controlled BP (under 140 mm Hg for systolic and under 90 mm Hg for diastolic) more than doubled by 3 months, to 78 percent for the in-class group and 80 percent for the mail group. Both groups also showed comparable improvements in psychological and behavioral outcomes. The study was funded in part by the Agency for Healthcare Research and Quality (HS13160).

More details are in "Mail education is as effective as in-class education in hypertensive Korean patients," by Dr. Kim, Eun-Young Kim, Ph.D., R.N., Hae-Ra Han, Ph.D., R.N., and others, in the March 2008 Journal of Clinical Hypertension 10(3), pp. 176-184.

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