Paper related to the cardiovascular disease in Chinese immigrants

Cardiovascular Disease in Chinese Immigrants Introduction Cardiovascular Disease (CVD) has been identified as the most prevalent health problem and the leading cause of death around the world, with Chinese immigrants in the United States having specific modifiable risk factors. These disparities are due to culturally enshrined restrictions, rudimentary or decreased health literacy, and scarce culturally appropriate healthcare facilities for this population. Appreciation of these differences should help in the reduction of disparities related to cardiovascular diseases among Chinese immigrants. The dispute herein is that limited culturally competent and tailored interventive strategies focus on clinical and sociocultural factors among the individuals in this particular community. Chinese immigrants still have a high prevalence of undiagnosed and uncontrolled major CVD risk factors, including hypertension and diabetes, and severe cardiovascular outcomes. The limitation of health literacy is also hindered by language differences, culture and Indigenous people's beliefs about health, and little exposure to the U.S. healthcare system. Based on the theoretical framework described above, the following culturally appropriate, community-based intervention is suggested in this paper: The thesis of this paper is that such an intervention can indeed narrow the health divide for Chinese immigrants, as evidenced by uptake in health literacy, heed paid to primary prevention, and cardiovascular health. The intervention is designed for Chinese immigrants living in urban settings where they experience a shortage of culturally appropriate health professionals. The clinical site will be a local community health center with face-to-face and telehealth service delivery modalities to increase reach. As the program is set within this specific population within a particular social context, the intervention is designed to develop a model that may be scaled across the ranges of immigrant populations with similar health risk profiles. Operational Definitions Definition of Key Terms in Terms of the Operations Cardiovascular disease (CVD) can be defined as any disease of the circulation originating from the heart and blood vessels, such as coronary artery disease, hypertension, stroke, and congestive heart failure. Health literacy, for our purposes here, is defined as one's ability to find, understand, and use information to make health care decisions. Cultural competence in treating patients is providing services that combine people's cultures to increase healthcare quality. For this study, Chinese immigrants are understood as first-generation persons born in China who have moved to the United States. This population primarily experiences unique healthcare problems because of cultural and linguistic differences and other constraints. Lastly, the type of intervention called a community-based intervention is a type of program targeted to the selected community setting, inclusive of educational and support programs with community health care providers tailored to meet the cultural requirements of the target community. Physiology and Health Assessments Cardiovascular disease among Chinese immigrant populations is culturally different and shapes pathophysiological and health-related risk assessment. Genetic susceptibility, lifestyle choices, and sociocultural factors increase CVD prevalence among the targeted population. Other chronic diseases, including uncontrolled BH and DM, are prevalent, and their early presentation to the healthcare facility is often hampered. Consumption of the traditional diet, combined with stress arising from acculturation, also elevates cardiovascular disease risk. This group's health assessments need to reflect these culturally informed practices since the use of traditional medicine may be a factor in this population. Annual checkups for blood pressure readings, lipid panels, and blood glucose testing are key but are rarely practiced because there is poor health literacy and inadequate access to culturally competent health care services. Solving these problems requires a multi-faceted approach in light of the attitudinal and biological factors determining human health. Specific Role of the APRN in Solving the Problem Cardiovascular health disparities in the Chinese immigrant population can only be solved by APRNs assuming key responsibilities. They are in a vantage position to enable the connection between the health care systems and culturally diverse societies. Another significant role of the APRN is to provide culturally appropriate health education programs concerning CVD with the National Heart Foundation of Australia. Such educational campaigns are specific to the Chinese immigrants' needs and beliefs, so the imparted information will be helpful and understood. In clinical practice, APRNs perform an assessment that moves beyond the traditional biomedical determinative to include cultural factors that might affect health (Harvey et al., 2022). Further, APRNs do community relations and ensure they work hand in hand with community civil structures and other stakeholders to ensure maximum health promotion and encourage the populace to embrace health promotion measures such as checkups. A third important function of the APRN is to perform the duty of coordinating the care of the patient. This is because many Chinese immigrants encounter language barriers and cultural clashes, which deny them effective communicative engagement with hospital staff. Study Impetus A comparatively higher proportion of Chinese immigrants have hypertension as compared to Whites; however, they were less likely to be aware of their condition and were less likely to receive treatment for it (Liew et al., 2019). Further, Chinese immigrants could have different stressors, which are sometimes associated with acculturative stress, leading to cardiovascular risks such as cortisol increments and hypertension. These specific risks affect Chinese immigrants and contribute to creating actions that can assist the population in question in receiving more effective therapy for cardiovascular diseases (Agyemang & van den Born, 2019; Huang & Garcia, 2020). Furthermore, this study addresses the tremendous need for improvement in public health literature on considering diversity with the concept of race and ethnicity. In many cases, Asian Americans are homogenized for study. Thus, many differences in health risk and health outcomes between Chinese, Filipino, Vietnamese, and Indian Americans are masked (Perera et al., 2024; Satish et al., 2021). In this context, this research is helpful as it is amenable to respond to a lack of studies and to help reduce the global imbalance regarding cardiovascular health and, in particular, Chinese immigrants, which will enable the conception of more accurate and efficient public health policies. This research aims to identify factors related to the incidence, determinants, and control of cardiovascular disease in Chinese immigrants in the United States of America. Essential CVD risk factors assessed in this study include hypertension, diabetes, cholesterol level, and non-conventional risk factors, including acculturation level, stress, and frequent cultural practices within this population. This study assesses this population's cardiovascular disease risk factors to design culturally appropriate prevention and management strategies. Background and Significance Cardiovascular Disease (CVD) is one of the major non-communicable diseases that continue to cause substantial mortality and morbidity globally. Hence, it has a considerable impact on the burden of disease. Cardiovascular disease still seems to be a leading public health issue in the United States, as it is estimated to be a cause of one in every three deaths (McClellan et al., 2019). People must understand that even though CVD impacts all races and ethnicities, the prevalence and distribution of the risk factors of cardiovascular diseases may differ within these groups. Chinese immigrants, one of the most rapidly increasing ethnic groups in the USA, can be regarded as rather distinct in this respect. Knowing the distinct, differently generalized recognitions and vulnerabilities relating to cardiovascular disease for Chinese immigrants will enable the design of effective tailored strategies and consequently correct the adverse health trend experienced among this group (Yang et al., 2019). Chinese immigrants, who form a large proportion of the Asian American population, cross a health divide based on several sociodemographic factors, language barriers, culture, and access to insurance. Nisar et al. (2023) and Liu et al. (2020) also revealed that Chinese immigrants have elevated risks of developing hypertension, diabetes, and metabolic syndrome, which are potent antecedents of cardiovascular disorders. In addition, lifestyle expectations such as food habits, physical activity, stress, and coping mechanisms may not be the same as those of the general populace of the United States, thus affecting the cardiovascular risk factors and their control (Arnett et al., 2019). Nevertheless, Chinese immigrants exhibit different risk profiles; ironically, they are often under-represented in cardiovascular studies; hence, the understanding of prerequisites, needs, and challenges in their population is poor. Significance Concerning cardiovascular diseases among Chinese immigrants, the following reasons make the effort necessary. First, this group is the largest Asian ethnic group in the USA, with more than five million people as per the 2020 Census USA (Kwan et al., 2023). Therefore, the effect of cardiovascular disease in this population will also rise steadily, making it a public health concern as this population expands. Besides, Chinese immigrants are disadvantaged by language barriers, cultural differences, low health literacy, and immigration status, which hinder them from accessing healthcare services and where to access them (Pandey et al., 2021). As a result, these barriers could lead to the development of these barriers as a cause of delayed diagnosis, inadequate management of cardiovascular risk factors, and overall poor health. Secondly, existing culturally sensitive and individually targeted prevention interventions and measures are scarce, especially for Chinese immigrants (Zeng et al., 2024). Although there is a standard set of recommendations for cardiovascular disease prevention, existing guidelines have not taken into account the more culturally specific issues, such as Asian Americans' food choices and the perception of health and disease. Review of Literature Methods and Results of Search A PRISMA diagram points out the main findings and shows how the identified articles were selected. As such, the present review aims to synthesize the cultural, behavioral, and structural drivers of CVD risk among Chinese immigrants and highlight potential research gaps. PICOT Framework and Clinical Question Question Type Definition Template PICOT Example Intervention/Therapy To determine which treatment leads to the best outcome In ___________ (P), how does ___________ (I) compared with ___________ (C) affect ___________ (O) within ___________ (T)? In Chinese immigrants with CVD (P), how does culturally tailored intervention (I) compare with standard care (C) affect cardiovascular outcomes (O) over 12 months (T)? Etiology To determine the most significant risk factors or causes of a condition Are ___________ (P) who have ___________ (I), compared with those without ___________ (C), at ___________ risk for ___________ (O) over ___________ (T)? Are Chinese immigrants (P) who have lower health literacy (I), compared with those without language barriers (C), at higher risk for poor cardiovascular outcomes (O)? Diagnosis/Diagnostic Test To determine which test is more accurate and precise in diagnosing a condition In ___________ (P), are/is ___________ (I) compared with ___________ (C) more accurate in diagnosing ___________ (O)? Do cardiovascular disease health interventions and programs involving the Chinese immigrants at risk for cardiovascular disease (Population) lower the prevalence of cardiovascular disease and promote improved health outcomes (Outcome) throughout a 10-year time frame compared to non-immigrants or other high-risk ethnic groups? Prognosis/Prediction To determine the clinical course over time and likely complications of a condition In ___________ (P), how does ___________ (I), compared with ___________ (C), influence ___________ (O) over ___________ (T)? How does increased health literacy (I), compared with standard care (C), influence long-term health outcomes (O) over five years (T) in Chinese immigrants with CVD (P)? Meaning To understand the meaning of an experience for a particular individual, group, or community How do ___________ (P) with ___________ (I) perceive ___________ (O) during ___________ (T)? How do Chinese immigrants (P) with CVD (I) perceive culturally tailored interventions (O) during their treatment (T)? Table 1: Showing PICOT Question First, it is possible to emphasize that the PICOT framework helped choose the clinical question for the literature review. POP is an acronym for Population, Intervention, Comparison, Outcome, and Time, and this model allows the researchers to ensure that the questions being asked are precise and significant. The PICOT question for this literature review is as follows: Do cardiovascular disease health interventions and programs involving the Chinese immigrants at risk for cardiovascular disease (Population) lower the prevalence of cardiovascular disease and promote improved health outcomes (Outcome) throughout a 10-year time frame compared to non-immigrants or other high-risk ethnic groups (Intervention). Literature Search Process For this research, the search for relevant literature was conducted across three primary healthcare and medical databases: PubMed, CINAHL, and the Cochrane Library. These databases were used because they cover peer-reviewed articles on health intervention, disease management, and culturally sensitive care. In particular, PubMed proved helpful, as it indexed clinical and population-based studies and CINAHL –more so because it covered research in nursing and allied health, which would be critical in assessing the available interventions for cardiovascular disease prevention and management. Systematic reviews and meta-analyses from the Cochrane Library were employed to identify evidence on the impact of health interventions on immigrant groups. Furthermore, the role of the professional associations, the Chinese American Heart Association (CNAHA) and the Asian Pacific Islander American Health Forum (APIAHF), in advocacy, education, and culturally appropriate healthcare was examined. These organizations are more realistic by providing an outlook on the interventions for Chinese immigrants, Asians, and other Asians in the community. The search terms used were drawn from the PICOT formula, and the following combinations of 'cardiovascular disease,' 'Chinese immigrants,' 'health intervention,' 'health disparities,' and 'immigrant health' were used as search terms in the article's title, abstract and keywords fields to filter out irrelevant studies. Moreover, filters have been set that excluded older articles before 2019 to focus on contemporary data, which excluded articles from non-refereed journals and limited the research to the United States and other developed countries with large Chinese immigrant populations. PRISMA Diagram The search conducted in this database produced 250 articles. This was after eliminating a total of fifty duplicates that were present in the database, which left two hundred articles that needed to be screened. In the initial step, the articles found in the above databases were screened with titles and abstracts for their applicability to the research question. We omitted articles not mentioning cardiovascular disease or Chinese immigrants; 100 were selected for abstract review. Of these, 30 articles were excluded as these did not contain or present the necessary interventions and comparison groups required for analysis, which reduced the analyzed pool to 70 papers. Based on this, 15 articles have been included in the literature review based on a final assessment. A total of 15 studies were conducted and offered the development of insights into cardiovascular disease in Chinese immigrants regarding cultural and behavioral health disparities or barriers to utilizing healthcare services and the use of interventions in health. -38099988900One hundred twenty articles were identified from essential databases such as PubMed, CINAHL, Cochrane, and Google Scholar (n=250).One hundred twenty articles were identified from essential databases such as PubMed, CINAHL, Cochrane, and Google Scholar (n=250).358140038100No additional records were found on further search (n=0).No additional records were found on further search (n=0). 13462001143000200 articles remained after the duplicates were removed (n=200)200 articles remained after the duplicates were removed (n=200)4445002667000Screened records were the 100 articles.Screened records were the 100 articles.4191000248920030 records were excluded after screening30 records were excluded after screening4953003708400Articles assessed for eligibility (n=70).Articles assessed for eligibility (n=70).42164003644900Articles excluded (n=55).Articles excluded (n=55).10541005435600Fifteen studies were included in the qualitative synthesis.Fifteen studies were included in the qualitative synthesis.160020067310016002006731003848100469900384810046990016383001714500163830017145003111500275590031115002755900316230039243003162300392430016637003022600166370030226001714500422910017145004229100 Figure 1: PRISMA Diagram Role of Professional Organizations Regarding CVD, there are organizations such as the CNAHA and APIAHF that balance an essential role of promoting the health of Chinese immigrants and the Asian community in general, including the fight against disparities. * The Chinese American Heart Association (CNAHA) CNAHA is a dedicated membership organization that promotes cardiovascular health among Chinese Americans. Chinese immigrants can get culturally appropriate primary and secondary schooling as well as health care services to reduce the awareness of the risks of developing heart diseases. CNAHA acknowledges that these people's genealogy, culture, and behaviors must be tackled differently (Beasley et al., 2019). It also provides free-of-charge medical services in the United States and related training in the United States and other parts of Greater China. By focusing on the fact that CNAHA facilitates professional exchanges between cardiovascular specialists of Chinese background, these healthcare givers are more prepared to handle the issues peculiar to Chinese immigrants. Through raising awareness of cardiovascular health among the population, CNAHA plays an intermediary role in assisting the integration of Western medical practice to the Chinese patients' needs. Their continued research on genetic susceptibility in specific cardiovascular diseases and a need to improve the access of Mandarin and Cantonese-speaking patients also supports culturally competent care, which has been marked to yield much better outcomes, according to Liu et al. (2020). * Asian Pacific Islander American Health Forum (APIAHF) APIAHF works along a broader canvas covering all sorts of Asian and Pacific Islanders living in the United States of America with a focus on cardiovascular issues, diabetes, and hypertension. APIAHF engages in research, policy development, and dissemination, focusing on heart disease and promoting culturally responsive practice (Chin & Ferati, 2020). APIAHF's outreach programs to ensure Chinese immigrants get adequate health care services include fighting language barriers, encouraging people to exercise their hearts, and offering them quality medical care. Through this forum, we have supported research that issues acculturation and economic stress as potent CVD risks for Asian immigrants. APIAHF has placed much emphasis on health disparities, including symptom reporting and reluctance to use services because of cultural taboos on illness. APIAHF has engaged in policy activism that promoted policy reforms meant to improve Asian immigrants' healthcare access so that the disparities related to cardiovascular health would decrease. Results of Search Literature review highlighting the following critical issues indicated to be essential for cardiovascular diseases among Chinese immigrants: First, I examined cultural and behavioral mediating factors that influence CVD risks among this population. Several works pointed to the impact of the pre-modern Chinese diet, characterized by the high use of salt and the scarce use of dairy. For instance, Nisar et al. (2023) confirmed that Chinese immigrants' eating habits are likely to trigger hypertension, which is among the causes of CVD. However, cultural beliefs that include the Chinese healthcare belief in the traditional approach of Chinese medicine and lack of willingness to seek Western healthcare further enhance these risks. Several reports showed that Chinese immigrants could be less likely to utilize Western medicine and may leave untreated cardiovascular disease or avoid taking prescription medication for this reason. Another prominent theme identified in the literature is the patient's healthcare rights regarding their access to treatment. Several reviews indicated that Chinese immigrants have poor health literacy, inadequate insurance, limited availability of translators and interpreters, and reduced ability to make and attend appointments to receive access to healthcare services, and this hampers their cardiovascular health. Pandey et al. (2021) also noted that Chinese immigrants who rarely access or understand English health insurance are less likely to take part in any preventive care or early detection programs for cardiovascular diseases. Again, communication problems, especially language, were stated to affect appropriate care because most Chinese immigrants are not able to talk to healthcare providers or adequately understand the healthcare system. The lack of culturally sensitive treatment further aggravates these disparities as most of the caregivers do not sufficiently meet the needs of the Chinese immigrants in the country. The literature also explored the feasibility and outcome results of using health interventions to reduce and control cardiovascular disease within the Chinese immigrant group. Several studies assessed community interventions that provide culturally appropriate education and services to reduce CVD risk factors. For example, McClellan et al. (2019) also identified that workshops about heart health in Chinese community centers effectively increased awareness of cardiovascular disease, dietary modifications, and more. However, despite the given interventions being effective in increasing knowledge and behaviors concerning cardiovascular health, the literature identified the absence of significant studies proving the effectiveness of such programs, in the long run, to modify the incidence degree of CVD and optimize health gains among Chinese immigrants. The comparative analysis helped widen the understanding of how CVD influences Chinese migrants compared to other groups. Comparing CVD outcomes in Chinese, Hispanic, and African Americans, Liu et al. (2020) concluded that Chinese immigrants are less likely to suffer from obesity or diabetes but considerably more prone to hypertension. Nonetheless, the authors of the study indicate that Chinese immigrants may be at an increased risk of cardiovascular diseases and thus recommend that they be addressed differently. In addition, the study isolated the need for more cross-cultural appropriateness in the program implementation, which remained a significant challenge since general health intercessions cannot be used to address the particular needs of Chinese immigrants. Thematic Discussion of Literature Review on Cardiovascular Disease in Chinese Immigrants CVD is a major health problem globally, and immigrants, especially the Chinese population in the United States, continue to suffer from this major killer. Such populations are likely to experience specific issues in terms of sociocultural, economic, and healthcare-related factors. This thematic review identifies and discusses five key themes: (1) Sociocultural Factors and CVD risk, (2) Lifestyle changes and health outcomes, (3) Barriers to healthcare access, (4) Culturally tailored interventions and (5) The role of technology in research and management. Theme 1: Sociocultural Characteristics and the Risk of Cardiovascular Disease Sociocultural factors that significantly predict the CVD risk of Chinese immigrants. According to Agyemang and van den Born (2019), immigrants are more likely to develop NCDs, including CVD, than the native population of the country. Such risks include stress arising from immigration and cultural change (Zeng et al., 2024). Immigration leads to new stressors such as language and social isolation, and the pressure to adopt a new culture, the client'...