---

Hypertension is a chronic health problem in both rural northern Japan and the southeastern United States. Researchers noted a continuing higher incidence of hypertension among rural residents with limited explanations of the contributing factors despite recent advances in the prevention and treatment of hypertension. This paper will describe the collaboration between Iwate Prefectural University Faculty of Nursing in Takizawa, Japan and University of North Carolina at Wilmington School of Nursing in the United States. The study group includes faculty and graduate students. The theme of the symposium is the commonalties and differences in cognitive, behavioral, and spiritual variables that are related to health promoting lifestyle and physiological outcomes among residents with hypertension from each country. An overview of the project and the process of designing the study by the international team will be described. The conceptual framework selected was a modification of Pender's Health Promotion Model. The study design and protocols will be presented. Measures used were the Walker Health Promoting Lifestyle ProfileII; the Morisky medication adherence scale; spirituality scales; knowledge of hypertension scale; and measures of blood pressure, cholesterol, height, and weight. The surveys were translated into Japanese and back translate by the Iwate study team. The design of the study provided an opportunity for both faculty and students to dialogue about and examine models and measures of health promotion, spirituality, health, and medication adherence that are useful in both cultures.