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Table 4 Intervention characteristics, adults

From: Effectiveness of diet and physical activity interventions among Chinese-origin populations living in high income countries: a systematic review

Author, year (ref) Study design Intervention group content Comparison group content Intervention group delivery Comparison group delivery Theoretical Basis Cultural Strategies Major Findings
Chesla 2016 [39] single-group repeated-measures Adapted Group Lifestyle Balance (GLB) curriculum: Cultural adaptation of the curriculum was conducted over 6 months by a team of nurses, a psychologist, and a social worker from a community agency that serves new Chinese immigrants. NA (a) a core phase, consisting of 12 weekly sessions over 3 months; (b) a transition phase, consisting of 4 sessions of decreasing frequency over 3 months NA NR Cultural adaptation involved a session-by-session review of education concepts, activation strategies, and behavioral examples. Three first-generation bilingual nurse research assistants (RAs) translated the GLB participant handouts, incorporating the modifications recommended by the research team. Translations of participant handouts were checked for appropriate diabetes language and concepts by a separate community certified diabetes educator, who worked in a health agency that serves Chinese immigrants. Treatment sessions were facilitated by first generation bilingual/bicultural nurse RAs who were trained in the GLB program. 5.4% weight loss at 6 months of the study. Total and low-density lipoprotein cholesterol improved. There were no statistically significant changes in fasting plasma glucose or A1C levels.
Chiang 2009 [40] two-group repeated measures quasi-experimental design Walking program modified to emphasize the Chinese cultural value of authority, family members’ involvement, harmony, and balance. Nonculturally modified walking program. NR NR Transtheoretical Model and Culture Care Theory This study intentionally added Chinese culture to only one of the groups. The walking program had no significant effects on blood pressure or walking endurance.
Deng 2019 [41] single-group, pre-post test design A home-based diet and exercise intervention that was designed to improve the physical function of cancer survivors. RENEW materials were translated into Mandarin Chinese (RENEW-C) with additional PA and dietary information to ensure that the information is culturally appropriate. RENEW-C goals for each day are to (1) walk at least 30 min, (2) eat at least 3 servings of fruits, (3) eat at least 4 servings of vegetables, (4) eat no more than 20 g of saturated fat, and (5) use the “Proportion Doctor” tool. NA Participants engaged in a 50-week program that consisted of (1) personally tailored workbook and series of quarterly newsletters, (2) 4 consultation sessions conducted by registered dietitians who reviewed the dietary lessons and problem-solve with survivors, (3) 13 telephone counseling and 4 prompts conducted by trained LSA staff and volunteers. Phone counseling and prompts were designed to enhance social support and self-efficacy, monitor progress, identify barriers, and explore resources NA Social cognitive theory/ Transtheoretical model The RENEW materials were translated into Mandarin Chinese. (RENEW-C) with additional PA and dietary information to ensure that the information was culturally appropriate. A focus group was held to evaluate the appropriateness and acceptability of RENEW-C materials. The suggested foods and corresponding caloric and fat contents in the workbook were changed to accommodate the dietary habits of Chinese Americans. After the intervention, participants consumed higher number of servings of vegetables and engaged in PA more frequently; more participants fell within the healthy weight range. Participants showed lower limitation in doing their work or other activities due to physical health or emotional problems and encountered less experience of psychological distress and social/role incapacity.
Lee 2017 [38] two-group, repeated measures quasi-experimental design Over a 12 week period, 1)motivational text messages to encourage walking were sent weekly; 2) Mobile phone cartoon illustrations to help cultural adaptation were sent once every 2 weeks; 3)Participants texted the program offices every 2 weeks with their daily steps for the prior week. 4)A text message report was sent at weeks 4 and 8 with a new suggested step goal. During weeks 13–24, no intervention was provided, but women continued to text their step counts every 4 weeks. 1) Two face-to-face meetings with a nurse interventionist 2)Walking manual, a pedometer, a walking step goal, and a walking step diary. 3)Participants called the program offices every 2 weeks to report their daily steps for the prior week. 4) A registered nurse spoke to women on the phone and reviewed and adjusted their step goals at weeks 4 and 8. 5) At 12 weeks, women met with the nurse interventionist to discuss and adjust step goals. During weeks 13–24, no intervention was provided, but women continued to call their step counts every 4 weeks. For each study arm, the principal investigator (PI) provided training sessions to the interventionists for the individual meetings based on the intervention manual. The PI directly observed the interventionist for the first 4 to 5 sessions and periodically thereafter to prevent drift. The interventionist who delivered the calls to the ST participants received training from the PI on setting step goals and how to limit the call to just providing the step goal. Individual meetings, phone calls to participants, and text messages were recorded in a spreadsheet and monitored weekly by the PI. NR The mobile phone cartoons were based on exit interviews with the 21 Korean Chinese women. They were asked, “What kind of information regarding everyday life would help you with adjusting to the Korean culture?” A graphic designer used the information to draw illustrations with cartoon captions of a typical daily encounter that presented an issue related to adjusting to their new culture. The illustrations included women learning about (1) the point card system utilized in a typical Korean grocery store, (2) laundering and dry-cleaning labels, (3) ordering coffee or drinks in common cafes, (4) communication skills, (5) the meaning of SPF sunscreen, and (6) nutritional values on food labels. A significant decrease was found in 10-year risk for cardiovascular disease (CVD), blood pressure, fasting glucose, body mass index, and waist-hip ratio at weeks 12 and 24 in both groups, but there were no significant group differences.
Lu 2014 [42] single-group repeated-measures 6-month program providing exercise, nutritional, counseling and social support to community residents with chronic diseases and mental health issues.1) 6-month membership to the YMCA was provided for a nominal fee based on income. 2) Participants met with a YMCA care manager weekly for a 1-h health education program. NA Half of the participants attended at least 70% of the 1-h education session with a mean attendance of 17 (63%) times out of a total of 27 sessions. Seventy-five per cent of the participants completed at least 46 exercise visits to YMCA during a 6-month period, with a mean value of 69.4 times per person, which translates into an average of 11.6 times per person per month. NA Wagner’s (1998) chronic Care model and multifaceted approach 1)Intervention location was convenient to elderly Chinese immigrants; 2)Bilingual and bicultural staff delivered intervention; 3) Reduced price YMCA membership to increase access for low income participants; 4)Primary care physicians referred patients to the program Significant decrease in body weight, BMI, systolic and diastolic blood pressure.
Sun 2012 [43] single-group repeated-measures 1) 12 biweekly 90-min support group sessions led by a multidisciplinary,bilingual team; 2) A bilingual 67-page booklet developed by CCHRC titled “Diabetes Management” was provided to participants. NA Program was implemented in a 6-month period. Program educators made follow-up reminder calls to encourage attendance and answer participants’ questions. Health promotion incentives were provided at no charge. A patient navigator was available 6 days per week to locate online bilingual health information for participants, provide additional guidance for utilizing glucose meters, and connect participants with potential resources that would aid in their diabetes management.A community-based participatory research approach was used to assess the effectiveness of Diabetes Self-Management. NA Chronic care model, Theory of reasoned action, and Social Cognitive Theory All instructional materials were written at a Chinese layman fourth-grade level. To ensure information was culturally appropriate, program educators incorporated Chinese commonly practiced activities and food items into the educational curriculum and in-person sessions. The class curriculum and handouts were focus group tested with the target population. Classes were held in a medical office building in San Francisco Chinatown, all activities were conducted in Cantonese, and participants were given a bilingual book on diabetes management. Statistically significant increases in glycemic control and diabetes knowledge. At 6 months after enrollment, 42.1% (n = 8) of the participants had a clinical significant glycemic control improvement by achieving ≥1.0% decrease in A1C; 31.6% (n = 6) had slight improvements in A1C (< 1.0% decrease); and 26.3% (n = 5) had no improvement or increase in A1C (≤ 0.0% decrease) from baseline. Statistically insignificant differences were shown in diabetes management practices. Secondary outcomes assessed participants’ perceived diabetes management and emotional and social support
Taing 2017 [37] single-group repeated-measures Promoted: 1) Increasing amount of moderate to vigorous intensity aerobic (150 min/week) and progressive resistance training (60 min/week) to 210 min/week; 2) Reducing percent total energy from fat and saturated fat intake to less than 30 and 10%, respectively; 3) Consuming at least 15 g/1000 kcal of dietary fiber intake; 4) Reducing body weight by 5% after 12 months. NA Assisted telephone interview survey was completed at baseline and 12 months; 2)1.5-h individual initial consultation with interventionist. 2) Three 2-h lifestyle group sessions;3) Three follow-up health coaching phone calls, lasting 20–30 min each, at 3, 6, and 9-months 4) Face-to-face individualreview at 12 months NA NR Consultations with an Advisory Group resulted in 1) Conducting the program entirely in Mandarin; 2)Translating all resources and materials to Mandarin; 3), Having two bilingual interventionists. Waist circumference, total cholesterol and fat intake significantly improved at 12-months.
Taylor-Piliae 2006 [44] single-group repeated-measures Yang Style 24-posture short-form Tai Chi was taught by an instructor with experience teaching olderadults. The Yang Style 24-posture short-form is easier to learnand remember than the classical Yang style 108-posture long form, though still contains the essential Tai Chi principles. NA 1) 60-min Tai Chi exercise class 3 times per week for 12 weeks, located at the community center; 2) Instruction to practice at home at least twoother days; 3) CD-Romof the instructor performing Tai Chi given at 12-weeks. Subjects were monitored for safety with corrections given as needed. NA NR Culturally relevant and appropriate forms of physical activity and exercise may contribute to better adherence. Tai Chi is a traditional form of exercise among Chinese populations. Intervention was offered at community center in both English and Cantonese Clinically and statistically significant reductions in blood pressure at rest (131/77), and in response to the step-test (164/82) were found over 12 weeks of TC (p < 0.01). No significant change in heart rate was observed.
Wang 2019 [45] single-group, pre-post test design A modified and tailored 12-week, DPP lifestyle modification course was developed based on identified topics from Chinese employees NA The course was adjusted to be delivered weekly on an individual basis to accommodate different work schedules. The 12-week course was delivered in Chinese by the project leader; educational materials in Chinese were handed out at each session to facilitate learning. The course was convened generally during the first shift’s lunch break or before the beginning of the second shift. NA NR Educational materials were translated into Chinese and adjusted to use common words, avoid medical vocabulary, break down long sentences to short phrases, and include pictures to facilitate learning. Participants showed an average reduction of nonfasting blood glucose of 30 mg/ dL (1.7 mmol/L), and a reduction of HbA1c by 0.32 points (3 mmol/mol).
Wang 2013 [31] RCT For each study arm (brown and white rice), all subjects were provided free rice. Subjects were encouraged to prepare rice items in their daily meals with the food items provided for the duration of the study and they were also advised not to change their usual patterns of cooking and eating. For each study arm, the supplies provided were enough to meet the calculated total energy requirements for a 4-week period. No rice was provided for the family or other household members. NR NR Significant decreases in weight and systolic and diastolic blood pressure among brown rice (intervention) group only. Insulin and HOMA, serum AGEs and 8-isoprostane decreased, while SIRT1 mRNA increased in the brown rice group as compared to the white rice group
Wang 1998 [46] single-group, pre-post test design Consultation with a diabetes nurse educator for an individualized meal plan, exercise plan, preventive plan for hyperglycemia and hypoglycemia, and foot care. NA Counseling by diabetes nurse educator; bi-weekly checks of blood pressure and/or blood glucose for one year NA Orem’s theory of self-care Conducted in Chinese; individualized meal plan per dietary preferences Eighty percent of participants had decreased their diastolic blood pressure from above 95 mmHg to below 90 mmHg and systolic blood pressure from above 155 mmHg to below 140 mmHg. Range of participants’ blood glucose levels also decreased from 126 mg/dL – 277 g/dL to 85 mg/dL – 226 mg/dL after participating in the program
Wang 2005 [47] single-group repeated-measures Intervention topics included 1) Nutrition 2) Exercise 3) Medication compliance; 4)Stress management; and 5) Foot and skin care activities. NA During the 10 weeks of the program, four sessions were offered on different days of the week to accommodate participants` schedules. The investigator and a registered nurse delivered the group sessions for up to 10 people. NA Empowerment model Classes were conducted in Cantonese, Mandarin, or Taiwanese. Because the Chinese translation for diabetes is sugar urine disease, many participants took the term literally and thought that they had to avoid only sweet tasting foods. Many participants reported that theirphysicians instructed them to consume less rice; subsequently, some participants avoided rice but consumed other carbohydrates (e.g., noodles or buns). Hence, the dietary education component of the program emphasized the concept of carbohydrates. 43.6% of the participants lost more than 5 poundsand most had a reduction in blood pressure at 3 months after completion of the program. Mean HbA1c decreasedfrom 7.11 to 6.12 post-intervention.
Yeh 2016 [32] RCT The Diabetes Prevention Program curriculum was adapted based on feedback from three focus groups of Chinese participants with pre-diabetes and one advisory group meeting. Diabetes prevention information provided through mailings 12 bi-weekly core sessions and six monthly follow-up sessions conducted by trained lifestyle coaches at a community site that could accommodate an exercise program. Quarterly mailings RE-AIM Sessions were conducted in Mandarin or Cantonese. Sessions were adapted to include more information about Asian diabetes risk disparity, following each intervention with a physical activity session (e.g. walking group or tai chi), inviting family members to attend sessions, providing measuring cups (especially rice bowls for portion control), as well as culturally and linguistically tailoring. There was a significantly greater percent weight loss in the intervention group (3.5 vs. 0.1%; P = 0.0001) at 6 months, which was largely maintained at 12 months (3.3 vs. 0.3%; P = 0.0003).
Zou 2017 [33] RCT Intervention components were usual care plus (1) the DASH diet pattern (2) sodium reduction; (3) Traditional Chinese Medicine food therapy Usual care consisted of: (1)hypertension health education booklet; (2) encouragement to see their primary health care provider regarding their blood pressure; (3) information on how to access local healthcare services (1) Intervention Manual and a refrigerator poster to summarize the dietary recommendations; (2) two 2-h classroom sessions; (3) 20-min booster telephone call 5 weeks post-randomization Information provided at baseline Traditional Chinese Medicine (TCM) principles of TCM food therapy: (1) light eating; (2) balance between the hot and cold nature of food; (3) harmony of the five flavors of food (sour, sweet, bitter, pungent and salty); and (4) consistency of diet withvarious health conditions. Intervention sessions delivered in Mandarin; incorporated Traditional Chinese Medicine into intervention components At 8 weeks post-randomization, those in the intervention group had greater reductions in systolic blood pressure [3.8 mmHg, t (55) = − 1.58, p = 0.12] compared to those of the control group.