Maintaining an outward image: a Korean immigrant's life with type 2 diabetes mellitus and hypertension

Top Ten Tips Palliative Care Clinicians Should Know About Caring for Filipino American and Korean American Patients

As of 2019, there are 4.2 million Filipino Americans (FAs) and 1.9 million Korean Americans (KAs) in the United States, largely concentrated in New York, California, Texas, Illinois, and Washington. In both populations, similar to the broader U.S. culture, one can find health literacy gaps around understanding and utilizing palliative care. In this article, we provide 10 cultural pearls to guide clinicians on how to sensitively approach FA and KA groups when addressing palliative and end-of-life (EOL) discussions. We fully celebrate that every person is an individual and care should be tailored to each person's goals, values, and preference. In addition, there are several cultural norms that, when appreciated and celebrated, may help clinicians to improve serious illness care and EOL discussions for members of these populations.

Self-Care in Korean Immigrants with Chronic Diseases: A Concept Analysis

Chronic illnesses among Korean immigrants (KIs) in the United States have been rapidly increasing, yet the concept of chronic disease self-care in this group has not been delineated. The aim of this study was to review previous research on self-care among KIs with chronic diseases and describe the concept in cultural context. Using Rodgers' Evolutionary Method, a total of 24 articles were analyzed. The definition and conceptual model of self-care in KIs with chronic diseases were proposed. The antecedents included knowledge and health literacy; social and family support; resources; patient-health care provider partnership; and elimination of cultural misbeliefs and disclosure of the disease. The attributes of the concept were aging well with diseases; treatment adherence; control and restriction; the acculturation process; care built on traditional Korean gender roles; and maintenance of mental health. The consequences involved positive physiological outcomes; self-efficacy; quality of life; and reducing worry about becoming a burden to the family. While the studied concept encompassed universal characteristics of chronic disease self-care, distinctive cultural features emerged. The findings contribute to a better understanding of chronic illness self-care in this population and the development of culturally sensitive and practical self-care interventions for KIs with chronic diseases.

Self-regulatory coping among community dwelling older adults with multiple chronic conditions

Objectives

Many older adults with multiple chronic conditions (MCC) frequently experience hospitalizations, functional limitations, and poor quality of life. Outcomes may be improved by promoting self-regulation, which may individuals respond to health threats and manage their health conditions. The aim of this study was to describe self-regulatory coping among older adults with MCC.

Methods

A qualitative descriptive study using semi-structured interviews and content analysis and guided by the Common-Sense Self-Regulation Model. Seventeen community-dwelling older adults with two or more chronic conditions participated in our study.

Results

Three themes were developed from the analysis: (1) "I don't think about it unless something happens": coping in the absence of a health event, (2) "doing what I am supposed to do": coping during a health event, and (3) "How do I know if what I did works?": appraisal of coping success.

Discussion

Self-regulatory coping was influenced by individual beliefs and experiences (illness representations), context, self-efficacy and availability of support and resources to cope with MCC. These findings suggest implications for clinical practice and future self-regulation interventions for older adults with MCC.

Religion, support and self-care experiences: A qualitative descriptive study with Indonesian adults with the chronic disease living in Montreal, Canada

AIM

To explore and describe the chronic illness self-care experiences of Indonesian immigrants living in Montreal, Canada and to gain a better understanding of how religion and support shaped these experiences.

DESIGN

Qualitative description.

METHODS

Data were collected from January to March 2020 via semi-structured interviews. Eight men and women participated. The data were thematically analysed.

RESULTS

Major themes identified were (1) religion, (2) being helpful to others, (3) family support, (4) transnational family support, (5) community support and (6) being in Indonesia versus Canada. Religion and faith were sources of motivation for self-care and provided guidance and strength to heal and accept the illness, mainly through the practice of prayer. 'Being helpful to others' (collectivism), including aiding others to avoid getting sick or giving 'health tips', and also just generally taking care of family also contributed to overall well-being. Spouses were the main source of assistance with disease monitoring and management and health maintenance, whereas support from the Indonesian community was minimal and mostly consisted of informational and social support. Transnational relationships with family members in Indonesia, however, provided an additional means for obtaining emotional support, advice and access to traditional medicines. Overall, there was little expectation that family or the community offer or provide support with self-care. These low expectations may partially be explained by the different cultural and social contexts in Canada compared with Indonesia.

CONCLUSION

Religious, cultural, social and family factors may be carried over from the home country and/or may be altered post-migration, and this may impact how Indonesian immigrants with chronic illness engage in self-care.

IMPACT

Cultural factors (collectivism, traditional medicines), religious beliefs and support networks, both locally and transnationally should be assessed and considered during care to better support and promote self-care among immigrants living with chronic diseases.

PATIENT OR PUBLIC CONTRIBUTION

Two Indonesian community organizations facilitated recruitment and data collection.

Patient Decision-Making About Self-Disclosure of a Type 2 Diabetes Diagnosis: A Qualitative Study

BACKGROUND

Effective self-management of type 2 diabetes requires receiving support, which can result from disclosing the diagnosis to a support network, including coworkers, family, and friends. As a primarily invisible disease, diabetes allows people to choose whether to disclose. This study qualitatively explores the factors that influence a person's decision to disclose diabetes to others.

METHODS

Research coordinators recruited 22 interview participants, ranging in age from 32 to 64 years, whose medical records included a diagnosis code for type 2 diabetes. Participants received care from one of two U.S. medical centers. Semi-structured interviews lasted approximately 1 hour and were audio-recorded and professionally transcribed. Verification strategies such as memo-keeping and maintaining methodological coherence/congruence were used throughout analysis to promote rigor.

RESULTS

In patients' descriptions of their decision-making processes regarding whether to disclose their diagnosis, six themes emerged. Three motivations prompted open disclosure: 1) to seek information, 2) to seek social support, and 3) to end the succession of diabetes, and the other three motivations prompted guarded disclosure: 4) to prepare for an emergency, 5) to maintain an image of health, and 6) to protect employment.

CONCLUSION

Based on our findings, we recommend three communicative actions for clinicians as they talk to patients about a diabetes diagnosis. First, clinicians should talk about the benefits of disclosure. Second, they should directly address stereotypes in an effort to de-stigmatize diabetes. Finally, clinicians can teach the skills of disclosure. As disclosure efficacy increases, a person's likelihood to disclose also increases. Individuals can use communication as a tool to gain the knowledge and support they need for diabetes self-management and to interrupt the continuing multigenerational development of diabetes within their family.

Health beliefs and chronic illnesses of refugees: a systematic review

Objective: To evaluate beliefs, and attitudes about health of refugees with chronic conditions such as diabetes mellitus type 2, hypertension, chronic obstructive pulmonary disease, and posttraumatic stress disorder and the consequent effects on self-care in comparison to resident populations.Design: A systematic review methodology was used. PubMed, Embase, PsycINFO and CINAHL databases were searched for relevant articles. The main terms analysed were health beliefs, chronic conditions and refugee populations. From 844 articles, 45 were retained for further assessment, and finally 5 met the inclusion criteria.Results: Differences in the health beliefs, attitudes and self-care management approaches of refugees compared to resident populations were identified in two studies. The remaining three papers did not make comparisons between the refugees and the resident population, nor did they specifically explore the refugees' health beliefs. Of the five studies, three were carried out in Sweden and two in the US. Refugees who have poorer mental and physical health as well as higher prevalence of chronic diseases than the populations among which they resettle seem to lack the knowledge about their illness, symptoms and self-management and thus are less able to control their chronic conditions.Conclusion: The findings highlighted the deficiency in the literature of studies which examine health beliefs and attitudes of minority groups such as refugees who have chronic conditions. The findings also gave insight to the need for a distinctive understanding of refugee health and the management of chronic conditions in comparison to other non-refugee migrant groups. Further research is needed to fully understand the differences between refugees and local populations in terms health beliefs, chronic disease and self-management.

Cultural Influences on Dietary Self-Management of Type 2 Diabetes in East Asian Americans: A Mixed-Methods Systematic Review

Purpose: Many East Asian Americans (EAAs) (populations originating from China, Korea, Japan, and Taiwan) with type 2 diabetes mellitus (T2DM) experience unique challenges in managing their disease, including language barriers and traditional cultural beliefs, particularly among first-generation immigrants.. The purpose of this mixed-methods systematic review was to examine cultural perspectives of EAAs that influence dietary self-management of T2DM and identify education interventions and their approaches to enhance EAAs' dietary self-management of diabetes. Methods: A mixed-methods systematic review was conducted to examine EAAs' perspectives from qualitative studies and to identify education interventions and their approaches from quantitative studies. A literature search was conducted using PubMed/MEDLINE, SCOPUS, CINAHL, and Web of Science from 1995 to 2018. Sixteen studies (10 qualitative and 6 quantitative) met criteria for analysis. Thematic synthesis of qualitative data was conducted using a line-by-line coding strategy. Extracted quantitative data were assessed for cultural approaches used in the interventions and diabetes-related outcomes. Results: In the qualitative studies, beliefs about food impacted EAAs' abilities to adopt appropriate dietary recommendations for diabetes management. Requiring a specialized diet disrupted social harmony and made EAAs feel burdensome to others. Having bilingual and bicultural resources eased the stress of making dietary modifications. The most commonly incorporated approaches in diabetes education interventions were bilingual education and culturally specific dietary recommendations. Social roles and harmony were not discussed. Significant reductions in hemoglobin A1c and increases in diabetes knowledge were reported post-intervention. Conclusions: Beliefs about food, beliefs about social roles, and access to culturally competent care play an important role in dietary self-management of T2DM among EAAs. Understanding the cultural influences on dietary self-management of T2DM and tailoring interventions to meet the needs of EAAs are essential in effort to address the growing epidemic and improve patient outcomes.

Contextualizing Experiences of Diabetes-Related Stress in Rural Dominican Republic

Type 2 diabetes (T2D) is changing the burden of disease across Latin America. In this formative, qualitative study, we explored experiences of T2D diagnosis and management among adults in rural Dominican Republic. We conducted 28 in-depth interviews (12 men, 16 women) and used inductive analysis to explore the emotional burden of T2D and identify coping strategies. We found that stress relating to T2D began at diagnosis and persisted throughout management. Stress was produced by concerns about healthy food and medication access, fears about illness-induced injury, and the cyclical process of experiencing stress. Participants identified diabetes care and free medication services as external stress-reducers. Internally, participants' mitigated stress by not thinking about diabetes (" no dar mente"). Our study highlights the importance of a contextualized understanding of diabetes-related stress and the need for individual, clinic, and community-level interventions to reduce stressors and improve health outcomes among adults with T2D.

Patients' Illness Perceptions of Type 2 Diabetes: A Scoping Review

BACKGROUND

People's personal perceptions, or illness representations, of type 2 diabetes can act as barriers to successful self-management.

INTRODUCTION

Understanding patients' subjective perceptions of type 2 diabetes can aid the design of evidence-based care and appropriate educational programmes. This scoping review provides a narrative account of previous knowledge of patients' illness representations of type 2 diabetes.

METHODS

Quantitative and qualitative studies that explored patients' illness representations of type 2 diabetes, as defined by Leventhal's Common Sense Model, were included.

RESULTS

Thirty four studies were identified for this review, but only 14 studies were carried out in a general population of people with diabetes. Illness representations varied across study populations. While it is clear that the perceptions of ethnic minorities and marginalised groups are embedded in their historical and cultural backgrounds, it is also important to understand the views of the wider population.

CONCLUSION

The review highlights the need for self-management interventions to reflect the target population's representations of type 2 diabetes in order to inform interventions and clinical practice.

Cultural Factors relevant to Korean Americans in Health Research: A Systematic Review

To eliminate health disparities in the United States, identifying cultural contexts salient to the target populations in an intervention study is critical; however, little research has been conducted on the identification of cultural contexts among Korean Americans who have significant risk factors for chronic diseases. This systematic review identifies critical cultural contexts central to the literature discussed in health research on Korean Americans. We examined 14 research reports of 801 potentially eligible articles published between 2000 and 2016 and analyzed their contribution to cultural contexts among Korean Americans based on the PEN-3 model. This review highlights how cultural contexts impact health and health behaviors of Korean Americans, and may contribute to health disparities in the United States. The key cultural contexts highlighted in this review include social support/social network, family, gender role expectations, and a holistic view of health and illness. These cultural contexts should be incorporated in designing culturally relevant, effective, and sustainable health interventions for Korean Americans, which will contribute to eliminating health disparities for this ethnic group who experience great obstacles to healthcare access and healthy behaviors.

Diet modification challenges faced by marginalized and nonmarginalized adults with type 2 diabetes: A systematic review and qualitative meta-synthesis

Objectives Diet modification is an important part of the prevention and treatment of type 2 diabetes, but sustained dietary change remains elusive for many individuals. This paper describes and interprets the barriers to diet modification from the perspective of people with type 2 diabetes, paying particular attention to the experiences of people who experience social marginalization. Methods A systematic review of primary, empirical qualitative research was performed, capturing 120 relevant studies published between 2002 and 2015. Qualitative meta-synthesis was used to provide an integrative analysis of this knowledge. Results Due to the central role of food in social life, dietary change affects all aspects of a person's life, and barriers related to self-discipline, emotions, family and social support, social significance of food, and knowledge were identified. These barriers are inter-linked and overlapping. Social marginalization magnifies barriers; people who face social marginalization are trying to make the same changes as other people with diabetes with fewer socio-material resources in the face of greater challenges. Discussion A social-ecological model of behavior supports our findings of challenges at all levels, and highlights the need for interventions and counseling strategies that address the social and environmental factors that shape and sustain dietary change.

Role of depression in diabetes management in an ethnic minority population: a case of Korean Americans with type 2 diabetes

BACKGROUND

Comorbid depression and diabetes mellitus (DM) compound challenges to disease management such as low health literacy, insufficient access to care, and social or linguistic isolation. Korean Americans (KAs), predominantly first-generation immigrants, suffer from a high prevalence of type 2 DM and depression. Limited research on KAs has prevented the development of effective interventions.

OBJECTIVES

To compare the prevalence of depression in KAs with DM and all Americans with/without DM, and to explore correlates of comorbid DM and depression and strategies to address KAs' DM and depression.

METHODS

KAs' data were from a clinical trial of a community-based self-help intervention to improve KAs' DM and mental health outcomes. National Health and Nutrition Examination Survey data sets enabled comparison. Clinical indicators included hemoglobin A1C, lipid panel, and body mass index. Psychobehavioral indicators included self-efficacy for DM management, quality of life, and depression (Patient Health Questionnaire-9 (PHQ-9)).

RESULTS

More KAs with DM had depression (44.2%) than did all Americans with DM (28.7%) or without DM (20.1%). Significantly more KAs with DM had mild (29.3%) or clinical (14.9%) depression than did Americans with DM (mild, 17.2%; clinical, 11.5%) or without (mild, 13.8%; clinical, 6.3%). One of six KAs with DM (16.9%) thought of suicide or self-harm (Americans with/without =5.0%, 2.8%). The self-help intervention reduced the mean PHQ-9 from 5.4 at baseline to 4.1 at 12 months.

LIMITATIONS

External validity might be limited; KAs' data were from one study site.

CONCLUSIONS

The prevalence of depression and DM among KAs warrants the development of efficacious interventions.

TRIAL REGISTRATION NUMBER

NCT01264796.

Evaluation of coping strategies in established rheumatoid arthritis patients: emergence of concealment in an Asian cohort

AIM

To evaluate coping strategies of Asian RA patients and their associations with health-related quality of life (HRQoL).

METHODS

A cross-sectional sample of patients with established RA was evaluated using measures of coping (Coping in Rheumatoid Arthritis Questionnaire [C-RAQ]; appraisal of coping effectiveness and helplessness), HRQoL (Mental and Physical Components [MCS/PCS] of the Short Form 12v2; Rheumatoid Arthritis Impact of Disease score [RAID]) and clinical/laboratory assessments. Principal component analysis was conducted to identify coping strategies. Multiple linear regression analyses were performed to evaluate the associations between coping strategies and HRQoL outcomes.

RESULTS

The study sample comprised 101 patients, 81% female, 72.3% Chinese, mean age 54.2 ± 12.6 years. Five coping strategies were identified: Active problem solving (E = 5.36), Distancing (E = 2.30), Concealment (E = 1.89), Cognitive reframing (E = 1.55) and Emotional expression (E = 1.26). Concealment was consistently associated with PCS (r_s = -0.23, P = 0.049), MCS (r_s = -0.24, P = 0.04) and RAID (r_s = 0.39, P < 0.001), and was significant in the multivariate model to explain lower disease-specific HRQoL (RAID) even after adjusting for disease activity, coping effectiveness and helplessness (β = 0.20, P = 0.04). Emotional expression was associated with poorer physical HRQoL (PCS), after adjusting for disease severity, body mass index, coping effectiveness, helplessness and Concealment (β = -0.39, P < 0.001). Perceived coping-related helplessness was significant in multivariate correlates for PCS (β = -0.25, P = 0.036), MCS (β = -0.29, P = 0.02) and RAID (β = 0.53, P < 0.001), after adjusting for covariates.

CONCLUSION

Concealment and Emotional expression are associated with lower disease-specific HRQoL and physical HRQoL respectively, with the former coping strategy likely to be culture-specific. Interventions should tailor psychosocial support needs to address not only coping strategies, but patients' perception of their coping.

Korean Immigrant Motherhood: Child-Rearing and Child Weight

Health problems among immigrant children may persist not only throughout childhood but also into adulthood. The purpose of this study was to elicit information about Korean immigrant mothers' experiences with parenting, immigration, and raising their children in the United States. Four focus group interviews were conducted in the Chicago metropolitan area. Content analysis showed that Korean immigrant mothers practice intensive parenting and worry about it. They described the strategies they use to raise healthy children. Culturally appropriate intervention programs are needed to reduce stress, encourage a healthy lifestyle, and link this to the health of their children.

The Effect of a Community-Based Self-Help Intervention: Korean Americans With Type 2 Diabetes

INTRODUCTION

Korean Americans are one of the most underserved ethnic/linguistic minority groups owing to cultural and institutional barriers; there is an urgent need for culturally competent diabetes management programs in the Korean American community for those with type 2 diabetes. The purpose of this study was to test the effectiveness of a community-based, culturally tailored, multimodal behavioral intervention program in an ethnic/linguistic minority group with type 2 diabetes.

DESIGN

An RCT with waitlist comparison based on the Predisposing, Reinforcing, and Enabling Constructs in Education/environmental Diagnosis and Evaluation (PRECEDE)-Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development (PROCEED) and self-help models. Data were collected between September 2010 and June 2013 and were analyzed in August-December 2014. Statistical significance was set at p<0.05.

SETTING/PARTICIPANTS

In a naturally occurring community setting, a total of 250 Korean Americans with type 2 diabetes were randomized into an intervention group (n=120) or a control group (n=130).

INTERVENTION

The intervention consisted of key self-management skill-building activities through 12 hours of group education sessions, followed by integrated counseling and behavioral coaching by a team of RNs and community health workers.

MAIN OUTCOME MEASURES

Primary (clinical) outcomes were hemoglobin A1c, glucose, total cholesterol, and low-density lipoprotein at baseline and at 3, 6, 9, and 12 months. Secondary (psychosocial and behavioral) outcomes included diabetes-related quality of life, self-efficacy, adherence to diabetes management regimen, and health literacy.

RESULTS

During the 12-month project, the intervention group demonstrated 1.0%-1.3% (10.9-14.2 mmol/mol) reductions in hemoglobin A1c, whereas the control group achieved reductions of 0.5%-0.7% (5.5-7.7 mmol/mol). The differences between the two groups were statistically significant. The intervention group showed statistically significant improvement in diabetes-related self-efficacy and quality of life when compared with the control group.

CONCLUSIONS

RN/community health worker teams equipped with culturally tailored training can be effective in helping an ethnic/linguistic minority group manage diabetes in the community.

The influence of social networks on self-management support: a metasynthesis

Background

There is increasing recognition that chronic illness management (CIM) is not just an individual but a collective process where social networks can potentially make a considerable contribution to improving health outcomes for people with chronic illness. However, the mechanisms (processes, activities) taking place within social networks are insufficiently understood. The aim of this review was to focus on identifying the mechanisms linking social networks with CIM. Here we consider network mechanisms as located within a broader social context that shapes practices, behaviours, and the multiplicity of functions and roles that network members fulfil.

Methods

A systematic search of qualitative studies was undertaken on Medline, Embase, and Web for papers published between 1^st January 2002 and 1^st December 2013. Eligible for inclusion were studies dealing with diabetes, and with conditions or health behaviours relevant for diabetes management; and studies exploring the relationship between social networks, self-management, and deprivation. 25 papers met the inclusion criteria. A qualitative metasynthesis was undertaken and the review followed a line of argument synthesis.

Results

The main themes identified were: 1) sharing knowledge and experiences in a personal community; 2) accessing and mediation of resources; 3) self-management support requires awareness of and ability to deal with network relationships. These translated into line of argument synthesis in which three network mechanisms were identified. These were network navigation (identifying and connecting with relevant existing resources in a network), negotiation within networks (re-shaping relationships, roles, expectations, means of engagement and communication between network members), and collective efficacy (developing a shared perception and capacity to successfully perform behaviour through shared effort, beliefs, influence, perseverance, and objectives). These network mechanisms bring to the fore the close interdependence between social and psychological processes in CIM, and the intertwining of practical and moral dilemmas in identifying, offering, accepting, and rejecting support.

Conclusions

CIM policy and interventions could be extended towards: raising awareness about the structure and organisation of personal communities; building individual and network capacity for navigating and negotiating relationships and CIM environments; maximising the possibilities for social engagement as a way of increasing the effectiveness of individual and network efforts for CIM.

The experience of the illness and of the treatment for the person with systemic arterial hypertension: an ethnographic study

OBJECTIVE

To interpret the meanings of the experience of the condition and of the treatment among people with arterial hypertension.

METHOD

The authors adopted the frames of reference of interpretive and medical anthropology and of the ethnographic method. 22 people with arterial hypertension, and 10 Family Health Strategy health workers, all from Minas Gerais, participated. The authors used interviews, participant observation, focus groups, field diaries and analysis of medical records. Ethical precepts were respected.

RESULTS

Two nuclei of meaning emerged: "The condition as an expression of way of living", and "The perspective of the cure of the condition". Nervous problems represent the nosological and symptomatic categories, caused by the urban way of living. The participants are supported by the belief of the curing of the problem. The family, spirituality and religion constitute social support networks. The therapeutic routes interpenetrate for the cure of the problem. The 'folk' health subsystem constitutes an important route because it provides better well-being and remission of the symptoms.

CONCLUSION

The gaps evidenced between the points of view of the health professionals and the interviewees allow one to re-think the praxis so as to provide comprehensive, contextualized and humanized care, which encourages the people's potential for living, for empowerment, and for self-care.

Health and psychosocial outcomes in U.S. adult patients with diabetes from diverse ethnicities

Within the United States, diabetes is a serious public health concern and patients with diabetes are more likely to experience clinical depression, psychological distress, and depressive symptoms than those without. Negative psychosocial factors are associated with poorer diabetes management and glycemic control. Overall, both the rates of diabetes and related psychological distress are greater for persons of diverse ethnicities than for non-Latino whites, and have reached epidemic proportions in certain groups. The following article will provide an overview across ethnicities of the rates of diabetes, health outcomes, psychosocial outcomes, and unique cultural and linguistic challenges that contribute to disparities within US diabetes patients of diverse ethnicities. Using this information, our hope is that health care practitioners and researchers alike can better respond to the psychosocial needs of ethnically diverse patients.

Understanding cultural issues in the diabetes self-management behaviors of Korean immigrants

PURPOSE

The purpose of this study was to explore potential factors affecting the self-management behaviors of Korean immigrants with type 2 diabetes mellitus (KIT2Ds).

METHODS

A qualitative descriptive design guided this study. Semistructured interviews lasting 45 to 60 minutes were conducted with 20 KIT2Ds in the participants' preferred language; in all cases, this was Korean. Each interview was audiotaped, transcribed, and analyzed using conventional content analysis. Data analysis was performed in two steps. The data written in Korean were initially analyzed by 3 bilingual researchers. A qualitative researcher then participated in the analysis to refine the findings for presentation to an English-speaking audience while staying true to the data and preserving the nuanced Korean meanings.

RESULTS

The mean age of the sample was 64. 5 ± 11.6 years (9 men and 11 women). The mean years of staying in the United States and age at diabetes mellitus diagnosis were 23.6 ± 9.7 years and 52.5 ± 12.3 years, respectively. Three major ideas were identified: (1) issues on treatment regimen related to medications and diet, (2) resources that helped or hindered ability to manage diabetes, and (3) the physician-patient relationship.

CONCLUSIONS

Important cultural nuances need to be addressed to better prepare KIT2Ds to manage their diabetes more effectively. A culture-specific program should extend beyond a diabetes self-management education delivered in Korean language. Rather, content and education methods need to consider acculturation effects on diabetes management behaviors.