title: A community and culture-centered approach to developing effective cardiovascular health messages.
abstract: OBJECTIVE
  Little is known about how best to target cardiovascular health promotion messages to minorities. This study describes key lessons that emerged from a community and culture-centered approach to developing a multimedia, coronary heart disease (CHD) patient education program (PEP) for medically underserved South Asian immigrants.
  
  
  METHODS
  The prototype PEP integrated the surface structures (e.g. language) and deeper structures (e.g. explanatory models (EMs), values) of South Asians' socio-cultural context. Seven focus groups and 13 individual interviews were used to investigate South Asians' reactions and obtain qualitative feedback after viewing the culturally targeted PEP. Qualitative data were organized into emergent thematic constructs.
  
  
  RESULTS
  Participants (n=56) mean age was 51 years and 48 % were Hindi speakers. Community members had a strong, negative reaction to some of the targeted messages, "This statement is a bold attack. You are pin-pointing one community." Other important themes emerged from focus groups and interviews about the PEP: 1) it did not capture the community's heterogeneity; 2) did not sufficiently incorporate South Asians' EMs of CHD; and 3) did not address economic barriers to CHD prevention. Feedback was used to revise the PEP.
  
  
  CONCLUSIONS
  A community and culture-centered approach to developing cardiovascular health promotion messages revealed tensions between the researcher's vantage point of "cultural targeting" and the community's perceptions and reactions to these messages. Engaging communities in every phase of message design, incorporating their EMs, recognizing community heterogeneity, and addressing economic and structural barriers, are critical steps to ensuring that health promotion messages reach their intended audience and achieve true cultural appropriateness.
authors.affiliation: Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA. n-kandula@northwestern.edu
authors.forename: Namratha R
authors.initials: NR
authors.lastname: Kandula
authors.forename: Neerja R
authors.initials: NR
authors.lastname: Khurana
authors.forename: Gregory
authors.initials: G
authors.lastname: Makoul
authors.forename: Sara
authors.initials: S
authors.lastname: Glass
authors.forename: David W
authors.initials: DW
authors.lastname: Baker
mesh_terms: D000328:Adult; D000368:Aged; D001208:Asia / Q000208:ethnology; D003153:Community Health Services / Q000379:methods*; D003327:Coronary Disease / Q000208:ethnology* / Q000517:prevention & control; D003466:Cultural Characteristics; D054242:Emigrants and Immigrants / Q000193:education; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000193:education; D010353:Patient Education as Topic / Q000379:methods*; D055815:Young Adult