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Health care and social service use among Chinese Immigrant elders

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Abstract

We explored patterns and reasons for health and social service use among Chinese immigrant elders. Interviews were conducted with 27 Chinese immigrant elders, 11 adult care giving children, and 12 health and social service providers. Content analysis of these data indicated that participants across groups agreed that Chinese elders under-utilize services because of problems related to language, transportation, cost, long waits for appointments, and because of cultural norms/values related to need for care, preference for self-over professional care, fear, and distrust of western biomedicine, and the obligation to refrain from using formal services. These problems are complicated by geographical dispersion and dialect differences in the local Chinese immigrant community.

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... The concept of "social services" corresponds to the Swedish terms "omsorg" and "omsorgsinsatser". Most were conducted in the USA [41] [42] [44] [46] [47], one in Israel [45], another in the Netherlands [48], and two in Sweden [40] [43]. ...
... Those studies that find under use of care also suggest that elderly immigrants have a greater need of health care input. Their ability to gain access and to use it is restricted, partly as a result of the economic reasons already mentioned [44] [45] [48]. ...
... Inability to speak the language and to communicate with others is one of the principle barriers [48]. Translation may be needed, sometimes even within one immigrant group, e.g. the Chinese [44]. ...
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Our premise for this literature review is the global demographic change caused by the world’s population living longer and becoming older, and extensive international migration leading to multicultural societies. Increasing age leads to health problems, often long-term or chronic, requiring investments in health care. Worse health and dissimilarities in pattern of morbidity/ mortality have been found in foreign-compared to Swedish-born persons, so it is reasonable to assume that this affects use of health care. The exploratory review focuses on elderly migrants’ (>65 years) use of healthcare. The databases Pub Med, EBSCO, CINAHL and ERIC were searched in 2000-2013. A limited number of studies were found; few had a comparative approach, most were from the USA, and focused on migrants from the former Soviet Union or countries in South-East Asia. A range of factors were identified that influence patterns of health care use: language fluency, ability to communicate, self-reported health status, prevalence of chronic disease, physical distance from care provision, availability of transport to reach care, cost of care, the health insurance system, cultural norms and values regarding different forms of care, level of education, and length of residence in the host country. Most studies treated health care from a general perspective and collected data from community and hospital settings, without analysing usage separately. Some studies indicated elderly migrants making use of health care less than other groups but the pattern is not unambiguous: other studies show that there is an overuse of health care. It is therefore difficult to show any particular pattern, or possible differences in use, regarding community versus in-patient care. Studies focusing on migrants’ actual use of health care are few and further research is needed, especially because elderly people form the largest group of users of health care and will be even larger in the future.
... poor English proficiency as a result of being a new immigrant [2,5,6,11,[15][16][17][18] ineffective communication with healthcare workers [15,19] lack of social, community, or family supports that may cause isolation and limit access to transportation and assistance with language interpretation [11,16] as well as health, cultural, or personal beliefs [12,15,20]. Many studies focused on utilization patterns of older immigrants indicate that beliefs about personal health needs and the appropriate time to ask family and professionals for help can influence when and if services are utilized [6,7]. ...
... poor English proficiency as a result of being a new immigrant [2,5,6,11,[15][16][17][18] ineffective communication with healthcare workers [15,19] lack of social, community, or family supports that may cause isolation and limit access to transportation and assistance with language interpretation [11,16] as well as health, cultural, or personal beliefs [12,15,20]. Many studies focused on utilization patterns of older immigrants indicate that beliefs about personal health needs and the appropriate time to ask family and professionals for help can influence when and if services are utilized [6,7]. ...
... Common factors that enable immigrant elders to use services include perceived need or health belief; the greater the perceived need often the more likely healthcare services will be utilized [11,15,16,20,21]. Other factors include longer residence in the country and increased English proficiency, family support (interpreter assistance, emotional support, or transportation) [22,17], and knowledge about accessing healthcare services [23]. ...
... As the US population is getting older and more diverse, such information is crucial to address the increasing health care needs of the rapidly growing older immigrant populations. and providing concrete assistance such as transportation, financial support, and help with paperwork (Aroian, Wu, & Tran, 2005;Pang, Jordan-Marsh, Silverstein, & Cody, 2003). Conversely, positive and supportive family relations may also be an impeding factor for older immigrants' service use by providing a mechanism for them to seek help within the home/family instead of using formal services (Marin, Escobar, & Vega, 2006). ...
... Conversely, two studies reported that Mexican immigrants with more children and higher levels of informal support had decreased service use, as strong family ties may supplement the need for formal health care (Nandi et al., 2008;Pescosolido, Wright, Alegria, & Vera, 1998). A study on Chinese older immigrants also found that the strong cultural norm of filial piety, that is, children's sense of duty to care for older parents, deterred Chinese elderly's use of formal services because that would indicate children's failure to fulfill their family obligations (Aroian et al., 2005). In addition, two studies on Asian immigrants reported lack of associations between informal support from the family and healthcare utilization (Chang, Chen, & Alegría, 2014;Ting & Hwang, 2009). ...
... Many Chinese Americans believe that family members have the duty to care for older family members with minimal outside assistance (Liu et al., 2017). Seeking help outside the family and using certain social services such as nursing homes and home health aides may be an affront to the family norms of filial piety, privacy, and mutual reliance (Aroian et al., 2005;Turner et al., 2016). Chinese older immigrants were also reported to feel embarrassed if their children failed to meet familial expectations by not being able to provide care when needed (Aroian et al., 2005). ...
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The family is the key for survival and success of the 4.6 million older immigrants in the United States. It is also an overlooked context to understand older immigrants' health service utilisation. Most prior studies on this topic either focus on individual or institutional factors that affect how older immigrants use formal health services. Using data from 2011 Population Study of Chinese Elderly in Chicago (N = 3,159), this study examined potential linkages between family relationships and health service utilisation among US Chinese elderly. Negative binomial and logistic regressions were carried out to investigate whether health service use of these older immigrants are related to positive family relations, negative family relations, and health-related communications among family members. The findings showed that positive spousal or family relations were not associated with either physician visits or hospital stays. However, respondents with more negative family relations had more doctor visits (β = 0.065, p < 0.05) and were marginally more likely to use inpatient services (OR = 1.15, CI: 0.88-1.04, p = 0.08). Respondents who talked to their spouse for medical concerns were less likely to use inpatient services (OR = 0.68, CI: 0.46-0.99, p < 0.05). The findings showed that family relations play a role in Chinese older immigrants' health service use. In addition, family conflict seems to be more influential than close family relations in predicting service use. Practitioners need to thoroughly assess family dynamics to fully understand the resources and barriers for health service utilisation among the older immigrant populations.
... Country of origin, tenure of working and citizenship also lead to a variety of healthcare experiences (Choi, 2009). Individual barriers such as linguistics (Choe et al., 2006;Aroian, WU & Tran, 2005), income differences (Hargraves and Hadley, 2003), as well as sociocultural barriers (Asanin and Wilson, 2008) are the key reasons for the imbalance in healthcare utilization among non-citizens (Ma, 1999). On the other hand, factors associated with structural barriers such as availability of health professionals (De Heer et al., 2013, Sanmartin & Ross, 2006, quality of healthcare services (Shrestha and Ittiravivongs, 1994), lack of transportation (Garces, Scarinci & Harrison., 2006;Aroian et al., 2005;Cristancho et al., 2008) and long waiting time are known to be among the obstacles towards getting healthcare services (Choe et al., 2006). ...
... Individual barriers such as linguistics (Choe et al., 2006;Aroian, WU & Tran, 2005), income differences (Hargraves and Hadley, 2003), as well as sociocultural barriers (Asanin and Wilson, 2008) are the key reasons for the imbalance in healthcare utilization among non-citizens (Ma, 1999). On the other hand, factors associated with structural barriers such as availability of health professionals (De Heer et al., 2013, Sanmartin & Ross, 2006, quality of healthcare services (Shrestha and Ittiravivongs, 1994), lack of transportation (Garces, Scarinci & Harrison., 2006;Aroian et al., 2005;Cristancho et al., 2008) and long waiting time are known to be among the obstacles towards getting healthcare services (Choe et al., 2006). Therefore, underutilization of health care services is a multifactorial issue (Shrestha & Ittiravivongs, 1994). ...
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Non-citizen labors in the country have been found to face difficulties in accessing healthcare services. The study seeks to investigate the existence of barriers in accessing primary healthcare services by non-citizen labors in Malaysia. This study was conducted on 323 non-citizen labors residing in the urban areas of Malaysia, particularly of Johor Bahru and Klang Valley from May to September 2017. Relevant information regarding the personal barriers (language, preference for physician's gender, difficulty taking leave from work), structural barriers (availability of public clinic in residential area, travel time to the public clinic, physician's knowledge and skill) and financial barriers (insurance coverage, fear of losing daily income, transportation costs) on using primary healthcare services at public clinics were obtained. The result of the analysis revealed that the barriers cited by non-citizens to seek primary healthcare in Malaysia were lack of medical insurance protection (75.1%), non-availability of a public clinic in the residential area (38.7%), not receiving the needed or wanted services (21.3%), long travel time to the nearest public clinic (17.3%), language (10.2% of respondents), negative perception about the doctors' knowledge and skills (9.9%), difficulty taking leave (7.8%), fear of losing daily income (7.7%), high transportation cost (3.7%) and different doctor gender preference (2.5%). Therefore, barriers to access healthcare services among non-citizens exist in Malaysia.
... Many studies show that immigrants face significant barriers in accessing health care. These barriers include lack of language proficiency [3,5,15,39,46], inability to afford health care [32,43], lack of transportation to health services [37,44], and lack of information about health conditions and services [3,31,4]. ...
... Many studies show that immigrants face significant barriers in accessing health care. These barriers include lack of language proficiency [3,5,15,39,46], inability to afford health care [32,43], lack of transportation to health services [37,44], and lack of information about health conditions and services [3,31,4]. ...
Article
Many studies show that immigrants face significant barriers in accessing health care. These barriers may be particularly pronounced for newer immigrants, who may face additional obstacles in navigating the health care system. Understanding the sources of health care disparities between recent and non-recent immigrants may allow for better design of policies and interventions to address the vulnerabilities unique to different subgroups of immigrants defined by their length of residency. This study employs descriptive analyses and multivariate logistic regression to estimate the likelihood of accessing and utilizing health care services based on immigration-related factors after controlling for predisposing, enabling, and health care need factors. We also employ a regression-based decomposition method to determine whether health care differences between recent and non-recent immigrants are statistically significant and to identify the primary drivers of healthcare differences between recent and non-recent immigrants. The findings support the hypothesis that significant disparities in health care access and utilization exist between recent and non-recent immigrants. We found that health care access and utilization differences between recent and non-recent immigrants were driven primarily by enabling resources, including limited English proficiency (LEP), insurance status, public assistance usage, and poverty level. These results indicate that not only are newer immigrants more likely to underutilize health care, but also that their underutilization is driven primarily by their lack of insurance, lack of adequate financial resources, and inability to navigate the health care system due to LEP. The results further indicate that immigrants with prolonged LEP may be less likely to have a usual source of care and more likely to report delays in obtaining medical treatments, than even recent immigrants with LEP.
... This article emerges from a scoping review of over two decades of relevant literature on immigrants' access to mental health services in Canada. Key online databases were searched to explore the gaps and opportunities for improving access to mental health services using a review framework provided by Arksey and O'Malley (Int J Soc Res Methodol 8: [19][20][21][22][23][24][25][26][27][28][29][30][31][32] 2005). Immigrants and refugees came from diverse religious and cultural backgrounds and had complex mental health-related concerns that were not currently being adequately addressed by existing services. ...
... Immigrants and ethnic minorities are underrepresented in the mental health care system and have been known to underutilize the mental health services [7,[17][18][19]. Variables related to the underutilization of mental health services in immigrant populations are age, place of origin, educational level, marital status, English skill, transportation problems, long waiting lists to get medical care, and preferences of one's own cultural services among others [20][21][22][23][24][25]. ...
Article
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This article emerges from a scoping review of over two decades of relevant literature on immigrants' access to mental health services in Canada. Key online databases were searched to explore the gaps and opportunities for improving access to mental health services using a review framework provided by Arksey and O'Malley (Int J Soc Res Methodol 8:19-32, 2005). Immigrants and refugees came from diverse religious and cultural backgrounds and had complex mental health-related concerns that were not currently being adequately addressed by existing services. The major barriers to the utilization of mental health services included: those related to the uptake of existing health information and services; those that were related to the process of immigrant settlement; and barriers related to availability of appropriate services. A thematic analysis of the range of recommendations that emerge from these studies for improvement of research, practice and policy is provided.
... There is a general consensus in the literature reviewed that older Chinese people face language and cultural barriers in accessing services, which places them at risk for isolation and various forms of abuse (Casado andLeung 2002, Sadavoy, Meier, andOng 2004). (Aroian, Wu and Tran 2005;Chan et al. 2016;Koehn 2009;Lee 2007;Li et al. 1999;Long et al. 2015). (Green et al. 2006;Kwok and Sullivan 2007;Li et al. 1999, Sproston, Pitson, andWalker 2001). ...
... Lai, Chau (2007a) and Chau and Yu (2010) also reported that practitioners' inability to understand the service users' culture was identified as a key barrier in using services. Other challenges and barriers include transportation, cost, long waits for appointments, and culturally insensitive care providers, and other organisational barriers such as norms and value conflicts (Aroian, Wu and Tran 2005;Jang, Lee, and Woo 1998;Ma 2000;Ngo-Metzger et al. 2003;Sadavoy, Meier, and Ong 2004;Tong 2000). All these barriers often result in a lack in older people's physical, emotional, and mental health and well-being (Arioan et al. 2005;Casado and Leung 2002;Lai and Chau 2007a;Sadavoy, Meier, and Ong 2004;Zhan et al. 1998). ...
Article
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This article presents the issues and challenges facing older Chinese immigrants in accessing mainstream services in Edmonton, Alberta, in Western Canada. A partnership was developed to advance knowledge in better understanding the provision of social services to this population. The study aimed to develop a comprehensive understanding of the needs of older Chinese immigrants and possible systems that would benefit from collaborative action and strategic engagement. Qualitative research was used to understand these issues with service providers in mainstream and immigrant-serving organisations and with Older Chinese from their perspectives. The awareness and access to mainstream services and information, perceptions of services, system improvements and use of social media are discussed. The article concludes with suggestions on how mainstream organisations can address diversity to better meet the needs of ethno-culturally diverse older immigrants in their programming and the implications for practice.
... Structural barriers are factors beyond the control of the individual or part of the context/environment. The most common structural barriers to accessing programs that provide social interaction are: lack of transportation and accessibility (Aroian, Wu & Tran, 2005); a lower income (Stephens, Alpass, Towers, & Stevenson, 2011); inadequate services (Gerts-Emerson et al., 2014); and lack of awareness of services available (Giunta et al., 2011;Tang & Pickard, 2008). All of these barriers prevent individuals from getting enough social interaction and are important contributors to the development of loneliness and isolation in ethnic minority elders. ...
... Most of these variables were used to control for the effect of structural barriers on the dependent variables. These control variables have been documented in the literature as being related to feelings of loneliness and of less supportive social networks (Aroain, Wu & Tran, 2005;Burnette, 1999;Scharlach et al., 2006;Lai, 2008). Control variables were entered in Step 1. Acculturation to Canada and 'family as referents' were entered in Step 2. Table 1 and Table 2 provide descriptive data on the 123 participants in this study. ...
Article
Objectives: Ethnic minority elders have high levels of social isolation and loneliness. Assumptions about the family providing enough social support exist in the literature, contradicting ethnic minority elders’ reported levels of isolation and loneliness. While structural barriers influence feelings of isolation and loneliness, limited information exists about the role of cultural factors such as acculturation and family values. Accordingly, this study investigated the roles of acculturation and family values on loneliness and social isolation among ethnic minority elders. Methods: Ethnic minority elders (N = 123) completed a questionnaire that assessed their social connectedness, measured by social network and levels of loneliness, and structural factors such as income. Additionally, cultural and family values were assessed by acculturation and the ‘family as referents’ dimension of familism, which refers to the belief that family members’ behaviour should meet with familial expectations. Results: Statistical analysis using hierarchical regression indicated that ‘family as referents’ and acculturation predicted loneliness, but not social network. Conclusions: This study raises the importance of considering cultural values when investigating predictors of loneliness among ethnic minority elders. Clinical implications: The finding highlight the importance of addressing familial expectations in programs aimed at alleviating loneliness among ethnic minority elders.
... Workforce development is of particular relevance to the Certificate in Health Studies experience at AUT as this is a course bridging into health degrees. It is known that immigrant groups, especially elder immigrants, under-utilise health services due to problems related to language and differences in cultural norms and values (Aroian, Wu, & Tran, 2005). The notion of cultural competency in nursing is at least 10 years old and is based on the idea that there is a need to address issues of cultural and linguistic diversity in health services (Blackford, 2005). ...
Article
This report first identifies some of the contextual issues affecting the tertiary education experiences of English as an Additional Language (EAL) students in New Zealand. It suggests that these issues are globally relevant and they include: a lack of evidence for tertiary policies regarding EAL students; a lack of understanding of how tertiary policies impact EAL students; a need to address these gaps in evidence and understanding. The report then outlines a project which was undertaken to track the progress of students who have passed through Auckland University of Technology’s (AUT) Certificate in Health Studies and enrolled in a health degree. A finding of this project was that successful paper completion rates of EAL students from the certificate programme exceeded those of the general student populace in the first semester of the health degrees. This finding has subsequently been used to facilitate policy changes in relation to EAL students exiting the certificate and gaining admission into a degree. The finding has also stimulated a commitment to continue to monitor the progression and outcomes of EAL students, by assisting in identifying internal institutional obstacles for these students.
... 26 The finding of underuse of the health service by the Chinese migrant community is in line with the extant literature. 25,26,[41][42][43][44][45] Further, immigrants tend to use emergency services rather than attending specialists or using preventive services. 43 Our study has a particular strength in that it focuses on a migrant community usually underrepresented in literature surveys and research; however, it has a number of limitations that need to be acknowledged. ...
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Tania Simona Re,1 Nicola Luigi Bragazzi,1,2 Anna Siri,1 César Cisneros Puebla,3 Susanne Friese,4 Mário Simões,5 Joël Candau,6 Hicham Khabbache7 1UNESCO Chair “Health Anthropology, Biosphere and Healing Systems”, Genoa, Italy; 2Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy; 3Department of Sociology, Metropolitan Autonomous University-Iztapalapa, San Rafael Atlixco, Mexico; 4Max Planck Institute for the Study of Religious and Ethnic Diversity, Göttingen, Germany; 5Medical Faculty, University of Lisboa, Lisboa, Portugal; 6Laboratory of Anthropology and Cognitive and Social Psychology (LAPCOS), University of Nice-Sophia Antipolis, Nice, France; 7Faculty of Literature and Humanistic Studies, Sidi Mohamed Ben Abdellah University, Fez, Morocco Abstract: Chronic pain represents a common public health concern worldwide. It is a complex phenomenon, owing to the interaction of different factors, including biological, physiological, psychological, environmental, and social variables. Some groups, such as women and immigrants, are particularly vulnerable. However, little is known about how Chinese women in Italy live with and face chronic pain. The present study aimed at filling this knowledge gap by examining the burden of chronic pain in Chinese immigrants in Italy in terms of acculturation processes, perceived control over disease, social networks, and coping strategies. A qualitative approach was used, performing a thematic field analysis. We interviewed 82 Chinese women from different Italian towns (Genoa, Milan, Turin, Bologna, Florence, and Prato) in depth. The sense of belonging to the host culture was strong in our sample. However, this did not simply reflect or translate into a linear engagement with medical systems, as health care pathways were more complex and dual (both Chinese and Western). Chinese women who felt deeply rooted in the Italian environment did not discontinue the use of traditional Chinese medicine. Chronic pain extensively and adversely affected daily life, particularly interfering with work. Coping strategies were mainly adaptive behaviors, being problem focused or maladaptive, relying upon “cope and avoid” mechanisms. Chinese women preferred to use traditional Chinese remedies rather than conventional medicine, while using the Italian system in emergencies. Perceived control over chronic pain was usually external. Finally, Chinese women with chronic pain benefit from social networks and support, which were mainly composed of Chinese peers. In conclusion, our findings underline the tremendous burden of chronic pain affecting all aspects of Chinese women’s lives. Health care workers and providers should be aware of the complexity of chronic pain Therefore, a holistic approach, involving different stakeholders, should be adopted when managing chronic pain and approaching immigrant patients. Keywords: chronic pain, Chinese immigrants, qualitative research, thematic field analysis
... Thus, physicians will likely interact with an increasing number of Chinese American immigrant patients. Previous studies [17][18][19][20][21] have found that certain aspects of Chinese culture, such as collectivism, influence Chinese Americans' beliefs about health and illness, communication in health care, and the utilization of Western health care. Thus, physicians should consider their cultural beliefs in FHH collection and communication to provide culturally appropriate FHH-based services. ...
Article
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Objective: Family health history (FHH) plays a significant role in early disease detection and prevention. Although Asian Americans are the fastest growing U.S. immigrant group, no data exists regarding Chinese Americans' (the largest Asian subgroup) views and use of FHH. This study examines this important issue. Methods: Forty-nine adults from southern U.S. Chinese American communities participated in this qualitative, semi-structured, in-depth interview study. Interviews were audio recorded, transcribed, and analyzed with a content analysis approach. Results: Although the majority of participants perceived the importance of collecting FHH, most lacked FHH knowledge and failed to collect FHH information. Barriers affecting FHH collection and discussion among family members included long-distance separation from family members, self-defined "healthy family," and Chinese cultural beliefs. Lack of doctors' inquiries, never/rarely visiting physicians, self-defined "healthy family," perceived insignificance of discussing FHH with doctors, and Chinese cultural beliefs were the obstacles in communicating FHH with physicians. Conclusions: Chinese Americans had limited usage of their FHH and faced cultural, distance, knowledge-, and healthcare system-related barriers that influenced their FHH use. Developing FHH education programs for Chinese Americans is highly recommended.
... Under the presence of these negative socioeconomic factors and communication difficulties, it is worth examining whether the phenomenon of a healthy immigrant effect exists. Immigrants' language proficiency and socioeconomic status directly influence their health status and indirectly influence their use of health services [37]. Religion can also be important, as it is frequently a method that immigrants use to address stress, reduce mental distress, and create a buffer effect against depression [38]. ...
Article
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In this study we examine whether there is healthy immigrant effect among women immigrated to Taiwan through transnational marriage. A sample of immigrant women (N = 246) with original nativity of Southeast Asian countries and Taiwanese-born women sample (N = 201) was recruited from December 2008 to December 2009. Their depressive symptoms, acculturative stresses and family functioning were assessed by a series of questionnaires. Immigrant women had lower depressive scores than their native-born counterparts when other potential confounders were controlled for in the multiple regression model. Our findings suggest that the healthy immigrant effect exists among immigrant women in Taiwan. Although such effect may due to immigrant women is a highly selective population with hardy mental characteristics, it is crucial to improve immigrant women’s mental health by helping them to enhance the ability of expressing emotions between family members as well as by mitigating socioeconomic inequality of cross-cultural immigrant families.
... However, only a few studies have tried using this model to explain physician visits. Although most studies of Asian immigrant elders have unequivocally found a pattern of underutilization, methodological challenges such as securing a sample led to those studies being conducted in major metropolitan cities with established ethnic communities in, for example, New York City [9], Boston [14], Chicago [15], and Los Angeles [16,17]. Factors contributing to healthcare service utilization among Asian immigrant elders living in places where systematic institutional support from the ethnic community is not readily available are unknown. ...
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Previous studies of healthcare service use among Asian immigrant elders have been conducted in major metropolitan areas with established ethnic enclaves. The factors that affect levels of utilization by Asian immigrant elders who live in places where systematic support from an ethnic community is not readily available are unknown. This study employed the Andersen-Newman healthcare service utilization model to examine unique correlates of healthcare service use among Chinese and Korean immigrant elders. Between 2005 and 2007, we used a snowball sampling method to collect data from Chinese (n = 116) and Korean (n = 101) immigrant elders living in Arizona. We then performed two negative binomial regressions based on ethnic background to identify factors associated with the number of annual physician visits. The results indicated that the number of medical conditions they experienced was positively associated with an increased likelihood of healthcare service utilization for both subgroups. However, the results indicated that each ethnic group had distinctive predisposing (sex and length of US stay for Chinese; marital status for Korean), enabling (English proficiency and cultural gap; insurance status), and need factors (depressive symptoms; self-reported health status) for predicting healthcare service utilization. Asian immigrant elders in this study experienced unique barriers and facilitators based on their ethnic backgrounds. Communicating with these two different groups in their native languages and better understanding their cultural backgrounds are imperative to understanding the factors related to their healthcare service utilization. Thus, rather than viewing Asians as a homogeneous population, the differences found in heterogeneous ethnic groups, such as language and cultural variations, should be taken into account when planning and implementing approaches to intervention.
... The ample attention international scholars pay to the relation between care services and immigrants shows that this is not an isolated Dutch phenomenon. Studies have shown that use of formal programs and services is often low among lower-income immigrants ðAroian, Wu, and Tran 2005; Hernández-Plaza, Alonso-Morillejo, and Pozo-Muñoz 2006; Kahanec, Kim, and Zimmermann 2013Þ; instead, their main sources of help and support are their own informal social networks ðAroian 1992; Leslie 1992; Martínez, García, and Maya 1999; Hernández-Plaza, Pozo, and Alonso-Morillejo 2004Þ. Volunteer organizations arising from within immigrant communities appear to be more effective at reaching low-income, marginalized immigrant groups that are not easily reached by Dutch institutions and professional services ðDe Gruijter, Tan, and Pels 2009; Bellaart and Pehlivan 2011Þ. ...
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Volunteer organizations can potentially partner with mainstream professional services to provide better parenting support to immigrant parents. This qualitative study of cooperation between professional agencies and volunteer organizations known as migrant volunteer and community organizations (MVCOs) aims to understand the extent to which professionals and volunteers can transform frame divergence from an obstacle into an advantage. Using frame analysis, this article explores the difficulties these groups encountered when they attempted to work together in two immigrant neighborhoods in Amsterdam. The divergence of the frames each group employed to define cooperation and its aims fueled mistrust and prevented attempts to work more closely together. The possibility of positively employing frame divergence to develop innovative solutions through frame reflection and reframing was hampered by the frame divergence itself, which was rooted in a long-standing controversy concerning roles, power relations, and patterns of inequality between the people involved.
... For Chinese in the United States, older Chinese immigrants may not utilize preventive care services which may exacerbate environmental conditions that prompt physical function decline. This may be due to lack of linguistic and culturally appropriate health care services or other service barriers such as cost, distrust of Western medicine, and transportation issues (21). Our previous work has found that U.S. Chinese older adults are vulnerable to functional impairment and related issues (22) and experience multiple disease and symptom burden (23), which have been identified as risk factors for functional impairment (10,11). ...
Article
Background Physical function decline is a major public health concern and can predict later mortality. This study aims to examine the sociodemographic factors associated with physical function decline among U.S. Chinese older adults through a longitudinal population-based study. Methods Data were derived from the Population Study of Chinese Elderly (PINE) at two time points: 2011–2013 and 2013–2015. Physical function was measured by observed physical performance testing, including chair stand, tandem stand, and timed walk. Mixed-effect models were used to analyze the demographic risk factors associated with physical function decline. Results Of the 2,713 participants in waves 1 and 2, their average age was 72.6 years old, 58.4% were female, with 8.7 years of education average, and 85.8% had an annual individual income of less than $10,000. Our findings show subjects of older age, female sex, lower education, lower income, and a greater number of medical comorbidities had lower physical function levels at baseline. Older adults experienced a faster decline in physical function for the overall performance measure (β = −.02, p < .001). Additionally, elderly adults with higher education have a faster decline of physical function in the overall performance measure (β = −.03, p < .01). Discussion As the first to examine physical function decline among U.S. Chinese older adults, our study finds older age and higher education are two factors associated with a faster rate of physical function decline. In future research, long-term follow up and multiple waves of data are needed to investigate risk or resilience factors for disability or recovering from disability.
... The findings of this study should be interpreted in the immigration context. Immigrant older adults often experience substantial linguistic, cultural, and mobility barriers (27,28). They are less acculturated to mainstream U.S. culture and rely on adult children for a great deal of support ranging from go for grocery shopping to access medical services (29). ...
Article
Background Elder mistreatment (EM) prevalence varies greatly according to definitional criteria. However, little is known regarding the significance of different EM definitions with respect to health outcome. This paper explores the association between different definitions of EM and their subtypes and suicidal ideation (SI) in an U.S. Chinese aging population. Methods The Population Study of ChINese Elderly in Chicago Study was conducted from 2011 to 2013 of 3157 community-dwelling Chinese older adults aged 60 years. Psychological, physical mistreatment (PM), caregiver neglect (CN), financial exploitation (FE), and overall EM were measured by different definitional approaches varying in the strictness. SI in the past 2 weeks and 12 months were assessed. Results After adjusting for confounders, the least restrictive EM definition (odds ratio [OR], 2.10 [1.34–3.28]; OR, 2.43 [1.66–3.55]), moderately restrictive EM definition (OR, 2.87 [1.80–4.56]; OR, 2.71 [1.82–4.04]), and most restrictive EM definition (OR, 2.24 [1.36–3.66]; OR, 2.34 [1.54–3.56]) were associated with increased risk for 2-week and 12-month SI. For subtypes of EM, psychological mistreatment (the least and most restrictive definitions, 2-week SI: OR, 2.83 [1.71–4.68]; OR, 3.13 [1.10–8.91]; 12-month SI: OR, 2.43 [1.56–3.78]; OR, 2.88 [1.10–7.54]), PM (2-week SI: OR, 5.12 [1.83–14.29]; 12-month SI: OR, 3.45 [1.30–9.13]), and FE was not associated with 2-week SI, only the broadly defined FE (OR, 1.73 [1.01–2.96]) was associated with higher odds of reporting 12-month SI. CN was only associated with higher odds of reporting 12-month SI (OR, 2.17 [1.19–3.96]; OR, 1.94 [1.24–3.04]) but not 2-week SI. Conclusion EM and its subtypes were significantly associated with SI; some associations varied by definitions and subtypes.
... acity to obtain additional information about their treatment regimen, communicate their needs and preferences with professionals, and even seek clarification of explanations.16,30 Chinese elders were also more likely to value self-care, peer advice, or expected care from their adult children over professional advice from a physician.24 Their desire for a collective approach to health management in a supportive learning environment with peers may further prevent Chinese elders from independently seeking individual doctor's appointments.16 ...
Article
Context: Type 2 diabetes mellitus is a global health issue among Asians, with rising prevalence and increasing disparities in proper disease management. However, studies on the perceptions of and attitudes toward diabetes, conducted to improve diabetes disparities, are disproportionately limited in Asian populations compared with other minority populations in the United States. Objective: To determine Chinese Americans' perceptions of and attitudes toward diabetes. Methods: Chinese Americans from the greater Los Angeles, California, area were asked to complete a survey. The survey was a self-administered 15-item true/false questionnaire to assess the respondents' perceptions of and attitudes toward diabetes. The results of the questionnaire were grouped by age: younger adults (aged <55 years) and older adults (aged ≥55 years). A subset of respondents in each age group was matched based on gender and education, and their responses were analyzed for differences in attitudes toward diabetes. Two-tailed t test and χ2 test were used to compare continuous variables and categorical variables, respectively. Results with P<.05 were considered significant. Results: A total of 449 of 485 Chinese Americans (93%) completed the survey. Among matched respondents (n=91 in each age group), more older respondents than younger respondents believed that (1) research on diabetes is solely beneficial for profiting pharmaceutical companies (23.1% vs 6.6%; P=.002) and (2) health insurance policies should not cover any costs of diabetes-related illnesses (28.6% vs 15.4%; P=.032). Conclusions: Older Chinese Americans were more likely to hold stigmatized negative perceptions of and attitudes toward diabetes in relation to pharmaceutical companies and health insurance policies. Considering that an individual's belief system largely influences self-care behaviors, actions should be taken to minimize negative perceptions of and attitudes toward diabetes.
... Therefore, those who receive more social support are more likely to receive health care services. A large size of social network improves elderly Chinese immigrants' utilization of western physicians, senior center services, dental care, and use of traditional Chinese medicine [37][38][39]. ...
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The immigrant populations in the U.S., especially elderly Asian immigrants, have increased significantly in recent years. With limited English proficiency and health literacy, elderly Asian immigrants are a vulnerable minority group with poor health outcomes, inadequate use of healthcare services, high healthcare costs, and mistrust on the U.S. healthcare system. Receiving support from social ties helps them to better utilize available resources within and beyond their community. The purpose of this paper is to systematically review the current social support and social network studies among elderly Asian immigrants. Our findings indicate that they receive emotional support from spouses, friends and neighbors, instrumental support from adult children (e.g. financial help), appraisal support from religious members (e.g. suggestion/feedback), and information support from ethnic communities. However, they have limited social ties and receive inadequate social support. Therefore, helping them expanding their social networks and operating social skills are effective for improving their well-being.
... Pregnancy status is a need factor in Andersen's (1995) model. In this study, pregnancy status is taken as a perceived need of WRA which refers to the health status, perceived by the individual and further cited by Aroian, Wu & Tran (2005) as "to how the individual view their health and whether or not they judge their problems to be of sufficient importance and magnitude to seek professional services" that leads to utilization of maternal health care services. Women, who have more children and who have high-risk pregnancy status, are more likely to utilize the BEmONC facility and its services because they recognize that there is a need to protect themselves. ...
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This descriptive correlational study was conducted to determine the maternal profile, awareness and utilization of Basic Emergency Obstetrics and Newborn Care (BEmONC) among women of reproductive age (WRA) in a rural municipality in Iloilo. The 346 respondents were selected using stratified random sampling technique. Data were gathered using a structured interview schedule prepared and validated prior to the actual data collection. For univariate, frequency, percentage, and mean were utilized to describe the data while Chi-square, Gamma, and Cramer's V were used to analyze and determine relationships between variables. The results revealed that most of the respondents were highly aware of the Rural Health Unit (RHU) as a BEmONC facility and its services. However, most of them have utilized only the prenatal package but not the childbirth and postnatal services. Hypothesis testing found a significant relationship between utilization of BEmONC services and employment status, income level, educational status, OB score, pregnancy status and awareness of BEmONC services. Increasing awareness about maternal and child health care and facility-based services and educating women planning for safe childbirth to deliver in a BEmONC facility that is attended by a skilled medical health professional are essential for the survival of the mother and the newborn.
... check-ups, thus societal norms towards routine health check-ups might be higher. Yet, due to the high healthcare cost and complex copayments and deductibles, compounded with language and transportation issues, Chinese immigrants might only visit doctors when very ill or when home-remedy do not work[18]. On the other hand, the convenient, affordable, and easy healthcare access in Taiwan might results in very different utilization patterns. ...
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Objectives This study examined cancer knowledge, beliefs, and practice among faith-based Chinese in the USA versus Taiwan to gain better understandings on how environment and culture might play a role for tailored cancer education programs. Methods A self-administered survey included a validated 10-item Cancer Screening Belief Scale (CSBS), an 8-item Cancer Screening Knowledge Test (CSKT), and a 14-item cancer Warning Signs Test (CWST) was administered. Participants were recruited from 9 Chinese churches (5 in the USA and 4 in Taiwan). Results A total of 372 Chinese participated, 50% lived in the USA and 50% in Taiwan. Mean age was 44.31 (standard deviation, 14.74), 60% males, and majority had college education (85%). Taiwan participants scored higher on both CSKT (6.13 vs. 5.52; p<0.001) and CWST (6.80 vs. 5.38; p<0.001). Although perceived screening benefits and barriers were similar, Taiwan participants endorsed higher on screening norms (11.67 vs. 10.82; p<0.001). Taiwan participants also indicated more doctor recommending cancer screenings (42.1% vs. 29.6%; p=0.015), USA participants were more likely to have had annual health exams (65.4% vs. 48.9%; p=0.002). Regression results showed that those resided in the USA were 2.38 times more likely to report annual health exams. Married status (odds ratio [OR], 2.85), college education (OR, 2.38), doctor’s recommendation (OR, 2.87), no family cancer history (OR, 2.47), and those with lower barriers were significant factors on annual health exams. Conclusions Taiwan participants scored higher on cancer knowledge and screening norms, while more USA participants reported annual health exams. Taiwan’s universal healthcare might play a role on the different healthcare seeking patterns.
... Yet each village and region in China can have a sub-dialect that only people from those regions understand (Aroian, Wu, & Tran, 2005;Chidarikire, Cross, Skinner, & Cleary, 2018). Former Soviet Union States may still speak Russian but most have reasserted their country's language as the primary language (Shpilko, 2006). ...
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Aim This paper seeks to describe best practices for conducting cross‐language research with individuals who have a language barrier. Design Discussion paper. Data Sources Research methods papers addressing cross‐language research issues published between 2000 ‐ 2017. Implications for Nursing Rigorous cross‐language research involves the appropriate use of interpreters during the research process, systematic planning for how to address the language barrier between participant and researcher and the use of reliably and validly translated survey instruments (when applicable). Biases rooted in those who enter data into “big data” systems may influence data quality and analytic approaches in large observational studies focused on linking patient language preference to health outcomes. Conclusion Cross‐language research methods can help ensure that those individuals with language barriers have their voices contributing to the evidence informing health care practice and policies that shape health services implementation and financing. Understanding the inherent conscious and unconscious biases of those conducting research with this population and how this may emerge in research studies is also an important part of producing rigorous, reliable and valid cross‐language research. This article is protected by copyright. All rights reserved.
... Less attention has been given to why this happens, rather just that it does. Thus, it has been suggested that Chinese people have relatively less checkups or professional care when feeling ill compared with the local population (Aroian, Wu, & Tran, 2005;Hsu-Hage et al., 2001). The general ideas from the literature are that Chinese people present late, usually with severe illness, and require costly interventions. ...
Article
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The health of older people is a priority in many countries as the world’s population ages. Attitudes towards help seeking behaviours in older people remain a largely unexplored field of research. This is particularly true for older minority groups where the place that they have migrated to presents both cultural and structural challenges. The UK, like other countries, has an increasingly aging Chinese population about who relatively little is known. This study used a qualitative grounded theory design following the approach of Glaser (1978). Qualitative data were collected using semi-structured interviews with 33 Chinese elders who were aged between 60 and 84, using purposive and theoretical sampling approaches. Data were analysed using the constant comparative method until data saturation occurred and a substantive theory was generated. “Being healthy” (the core category) with four interrelated categories: self-management, normalizing/minimizing, access to health services, and being cured form the theory. The theory was generated around the core explanations provided by participants and Chinese elders’ concerns about health issues they face in their daily life. We also present data about how they direct their health-related activities towards meeting their physical and psychological goals of being healthy. Their differential understanding of diseases and a lack of information about health services were potent predictors of non–help seeking and “self” rather than medical management of their illnesses. This study highlights the need for intervention and health support for Chinese elders.
... ;Pang et al. (2003);Aroian et al. (2005);Wong et al. (2006Wong et al. ( , 2005Wong et al. ( , 2007; Lee (2007); Mui et al. (2007); Chiang and Sun (2009); Parikh et al. (2009); Chun et al. (2011); Dong et al. (2012a, 2012b, 2014); Kang et al. (2012); Lin et al. (2014); Wyatt et al. (2014); Kim et al. (2015, 2017); Kwon et al. (2015); Tsoh et al. (2016); Dong and Chang (2017); Hei and Dong (2017); Zhan et al. (2017) ...
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Neighbourhood environment has a significant impact on the health and wellbeing of older people. In recent years, the increase in older Chinese immigrants globally has attracted a growing amount of research which has investigated the health and wellbeing of these elderly residents. The aim of this study is to provide a systematic literature review of empirical findings on the health and wellbeing of older Chinese immigrants and the ways in which the neighbourhood environment impacts them. A systematic search was conducted using online databases where 52 articles met specific criteria and were subsequently reviewed critically. An inductive approach was undertaken to analyse the data extracted from the selected articles. The review was categorised according to the following themes: neighbourhood social environment, neighbourhood physical environment and place attachment. The findings show that the majority of research has investigated the health status of older immigrants, and in particular, the impacts related to the social environments in which they live. The literature review indicated that there is scope for future studies to investigate the impact of the physical neighbourhood environment on this group of people.
... These factors, for the most part, are consistent with the variables used in the Andersen model [19,20]. Other factors we noted are unique to the racial and ethnic minority populations [22,23]. ...
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Guangzhou, one of China’s largest cities and a main trading port in South China, has attracted many African businessmen and traders migrating to the city for financial gains. Previous research has explored the cultural and economic roles of this newly emerging population; however, little is known about their health care experiences while in China. Semi-structured interviews and focus groups were used to assess health care experiences and perceived barriers to health care access among African migrants in Guangzhou, China. Overall, African migrants experienced various barriers to accessing health care and were dissatisfied with local health services. The principal barriers to care reported included affordability, legal issues, language barriers, and cultural differences. Facing multiple barriers, African migrants have limited access to care in Guangzhou. Local health settings are not accustomed to the African migrant population, suggesting that providing linguistically and culturally appropriate services may improve access to care for the migrants. http://link.springer.com/article/10.1007/s10903-014-0114-8
... Public discourse about immigration in America has long featured contentious debates about immigrants' economic contribution and about the costs of absorbing immigrants into American society. Today, prominent voices continue to contend that foreign-born individuals harm economic prospects for native-born workers and burden to the US public welfare system if they fail to achieve financial independence-an argument that stands in contradiction to most empirical research that shows immigrants have little impact on the employment and wage rates of native-born workers (Longhi, Nijkamp, and Poot 2010;Card 2005), rely on public assistance no more than the native-born (National Population Research Council 1997;Lee and Miller 1998;Watson 2014;Engelman et al. 2017), and underuse social services (Aroian, Wu, and Tran 2005;Whitley, Kirmayer, and Groleau 2006). ...
Article
Researchers and policymakers frequently debate about the integration of immigrants into the US economy. These debates are often based on limited data that do not capture the diversity of immigrants who arrived in the later twentieth century. Related research has also struggled to incorporate the experience of short‐term immigrants or immigrants who move in and out of the labor force. Using records from the Social Security Administration, we track the complete cohort of foreign‐born men who received social security numbers in 1978 through their subsequent working years and characterize their earning trajectories. We find that the share of foreign‐born men with low earnings declined over time, mainly due to attrition from the formal labor force. We also show, for the first time, that immigrants’ employment and earning histories vary considerably by their countries of origin: while those from several countries in Asia and Africa experienced substantial earnings growth and tended to stay in the United States for the long term, men from Central America and the Caribbean experienced more stagnation and had high levels of temporary and permanent attrition from the formal labor force. We end by discussing the historical contingencies and socioeconomic contexts—in sending countries and the United States—that shaped these trajectories.
Article
Depression is a global public health problem, with broad social, economic and personal consequences. However, there exists incomplete understanding of the psychological distress of Chinese older adults, which is often exacerbated by the cultural and linguistic barriers at the individual, family and community levels. This paper reviews the epidemiology of depression among Chinese older adults and also explores the barriers to treatment. Since depression in the Chinese aging population is a multifaceted issue, a culturally appropriate and interdisciplinary approach to improve the quality of life and quality of care for the Chinese older adults is critical. We propose that leveraging cultural humility models in conjunction with existing cultural competency training could be a novel strategy to enhance training of healthcare professionals dealing with depression in Chinese aging populations. Future research is needed to explore the causal mechanism and consequences associated with depression in representative Chinese aging populations.
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Despite growing interest in the community-based participatory research method, limited empirical research exists on how to overcome cultural and linguistic barriers in applying community-based participatory research principles within the Chinese elderly community. This article reports on the implementation of a participatory process to assess the health needs of an aging Chinese population. We recorded challenges faced and lessons learned in collecting pilot data on issues pertaining to the health of a community-dwelling older Chinese population (over 60 years of age) in Chicago's Chinatown (Chicago, IL, USA). We have learned that establishing partnerships with a humble approach, acknowledging community diversity in languages and cultures, building on community strengths, and empowering community through education are important considerations in this collaboration. Implications of these findings for research and practice are discussed.
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In 2008, the United States government increased the importance of standardized English in the naturalization process. Using semistructured interviews, surveys, and participant observation data, this article explores language barriers to naturalization through a Chinese immigrant community in Southern California. As part of the nation’s fastest-growing racial group in the United States, Chinese immigrants are a significant piece of the immigration and naturalization picture. Recommendations for culturally responsive strategies for social workers are discussed. Since Chinese immigrants tend to underutilize services, social workers may play a central role in assisting immigrants through the naturalization process and thus accessing social services available to citizens.
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Health disparity across ethnic and immigrant groups are well recognized. However, there is a lack of systematic understanding about health disparity among older adults particularly given the growing number and size of minority and/or immigrant elders in the United States. The chapter relies on published studies, relevant monographs, government reports and Census data; it explores possible ways in which minority and immigration status jointly or independently affects elderly health. The chapter then introduces the community social capital as a theoretical framework to understand elderly health disparity. In essence, it argues the magnitude of structural racism in the life of minority and immigrant older adults; and it discusses the role that community social capital might play to moderate the negative effects of social-economic disparity, community segregation, social discrimination, and other factors contributable to health outcomes.
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Although the need to make health services more accessible to persons who have migrated has been identified, knowledge about health-promotion programs (HPPs) from the perspective of older persons born abroad is lacking. This study explores the design experiences and content implemented in an adapted version of a group-based HPP developed in a researcher-community partnership. Fourteen persons aged 70-83 years or older who had migrated to Sweden from Finland or the Balkan Peninsula were included. A grounded theory approach guided the data collection and analysis. The findings showed how participants and personnel jointly helped raise awareness. The participants experienced three key processes that could open doors to awareness: enabling community, providing opportunities to understand and be understood, and confirming human values and abilities. Depending on how the HPP content and design are being shaped by the group, the key processes could both inhibit or encourage opening doors to awareness. Therefore, this study provides key insights into how to enable health by deepening the understanding of how the exchange of health-promoting messages is experienced to be facilitated or hindered. This study adds to the scientific knowledge base of how the design and content of HPP may support and recognize the capabilities of persons aging in the context of migration.
Article
As the Asian American immigrant population grows older, daily care, mental health, and access to services may present particular difficulties for this population and their children. Specifically, due to vast differences between Eastern and Western cultures, children (second-generation Asian Americans) may not share the same philosophy of care as their elders. Consequently, this cultural dissonance between generations can result in adverse mental health outcomes for both elders and their family members who are involved in caregiving activities. The situation is exacerbated given the lack of culturally sensitive professionals and resources to serve this population in local communities. In this article, an examination of these intergenerational dynamics will be followed by practice suggestions for appropriate interventions at the community level.
Article
Objectives: Depression has become one major mental health concern among Asian older adults. Yet, less is known about the role of social support on depression help-seeking among this population. This study examined the association between positive (i.e., open up to, rely on) and negative (i.e., too many demands, criticism) social support and depression help-seeking among U.S. Chinese older adults. Methods: Data were derived from the Population Study of Chinese Elderly in Chicago (PINE). Study sample consisted of 994 U.S. Chinese older adults with depressive symptoms. Results: Stepwise logistic regression results indicated that greater positive social support was associated with increased likelihood of both formal and informal help-seeking behaviors, whereas negative support was not a significant predictor. Discussion: Findings highlight the key role of positive social support in influencing U.S. Chinese older adults’ depression help-seeking behaviors. Tailored strategies are recommended to better meet the mental health needs of this vulnerable population.
Article
Engaging immigrants in preventive health care programs, such as vaccination, constitutes a challenge. Existing programs tend to conflate issues related to immigrant status with ethnic or racial minorities. These programs also tend to ignore that acculturation and cultural discourse in health may vary depending on the immigrant subgroup and the host community’s social environment. This paper addresses the gap in the literature by proposing a conceptual framework that uses a socioecological perspective to outline acculturation and cultural factors in immigrants’ preventive health behaviours. To this end, we synthesized the literature on acculturation and cultural perspectives on preventive health among immigrants. We used a case study on influenza vaccination among Chinese immigrants to illustrate the importance of targeting and tailoring approaches to specific immigrant subgroups. We performed a critical examination of 10 existing influenza vaccination programs adapted for immigrants and ethnic minorities to outline their cultural sensitivity in surface- and deep- structure components. Finally, we proposed a conceptual framework integrating the acculturation factors, cultural elements, and cultural anatomy of the reviewed programs with application to Chinese immigrants as a demonstration of cultural sensitivity. The discussion includes limitations, recommendations, and future directions resulting from this framework to help inform cultural adaptation of preventive health programs for immigrants.
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A dilemma one may face in analyzing qualitative data is whether to use a manual approach with index cards or a computer data management tool like ATLAS.ti. This paper compares the two approaches in organizing and analyzing data using the same data set. The data were collected and first analyzed in a constructivist inquiry course according to the methods laid out by Rodwell (1998). This process involved unitizing data onto index cards and these cards were then sorted into categories during the constant comparison process. Later, the same data were linked to ATLAS.ti where they were unitized and categorized simultaneously. Constant comparison took place when all the data were coded. A comparison of the two methods allowed the author to determine the strengths and limitations for the various stages of constant comparison.
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Older adult immigrants are often socially isolated and vulnerable to poor health. Adult day service (ADS) centers could potentially facilitate social integration and address their long-term health care needs. The current review (a) identifies barriers to and facilitators of ADS use among immigrants, (b) explores how ADS programs impact older adult immigrants' health and well-being, and (c) isolates the most effective culturally based components of ADS programs. An integrative review was conducted using Whittemore and Knafl's methodology. Four databases were searched. Articles were critically appraised and data were organized within an ADS-specific framework. Functional impairment, race, gender, and degree of loneliness were all predictors of ADS use. ADS enhanced immigrants' quality of life and provided fulfillment. Transportation, bilingual nurses, peer support, and cultural activities were deemed essential by participants. ADS can provide support to older adult immigrants by adding cultural elements to existing services and using nurses as cultural liaisons. More research is needed to assess the impact of ADS on disease outcomes, including dementia, and on immigrants in multi-ethnic settings. [Res Gerontol Nurs. 20xx; xx(x):xx-xx.].
Article
Background The authors aimed to measure population-based preventable emergency department (ED) visits related to infectious oral conditions (IOCs) in Massachusetts and to examine the associated sociodemographic factors to support prevention efforts. Methods A statewide retrospective analysis of ED visits related to IOCs in Massachusetts from 2014 through 2018 was conducted using a Center for Health Information and Analysis database. The authors described patients' characteristics, dental diagnoses frequencies, emergency severity, lengths of stay, associated treatment, and costs. Multilevel logistic regression was used to assess factors associated with IOC visits. Results IOC visits in 2014 through 2018 were 1.2% (149,777) of the total ED visits, with an estimated cost of $159.7 million. There was an annual decline in the prevalence of IOC visits from 2014 through 2018. After adjusting for sociodemographic factors, odds of IOC were higher among males (adjusted odd ratio [AOR], 1.26; 95% CI, 1.24 to 1.27), non-Hispanic Blacks compared with non-Hispanic Whites (AOR, 1.03; 95% CI, 1.02 to 1.06), people residing in dental health care professional shortage areas (AOR, 1.06; 95% CI, 1.04 to 1.07), public insurance beneficiaries (AOR, 1.90; 95% CI, 1.87 to 1.93), or uninsured (AOR, 2.60; 95% CI, 2.54 to 2.66) compared with privately insured. Conclusions There was an annual decline in the prevalence of IOC visits from 2014 through 2018. Higher odds of IOC visits were associated with young adults, Black patients, uninsured people, public insurance beneficiaries, and people who reside in dental health care professional shortage areas. Practical Implications The authors provided statewide data to support proposed policies to improve oral health care in Massachusetts. IOCs are mostly preventable, but well-coordinated care between medicine and dentistry is integral for prevention.
Article
Cambodian Americans are a growing subgroup of the Asian Pacific American population in the United States but they have largely remained invisible. This invisibility may have contributed to social services needs being unmet. This study sought to identify strategies for increasing access and utilization of social services for Cambodian American refugees that are culturally-informed. A qualitative approach was taken that enhances the ability to ascertain 29 social service providers’ perspectives who specifically serve the population through ethnic-specific social services programs/agencies. Themes emerged from the data as strategies for increasing access and service utilization of social services including 1) providing a welcoming environment to increase the possibility of Cambodian Americans using services and return rates; 2) having bilingual and bicultural service providers to help Cambodian Americans feel understood and develop a stronger sense of trust; 3) engaging in community outreach to increase awareness of available services; 4) embracing culture and spirituality to demonstrate respect and understanding; and 5) developing patience by assisting with various needs in order to build trust. Implications of the findings from the study provide specific strategies for providers and agencies to consider adopting in order to increase access and service utilization of social services among Cambodian American refugees.
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Studies of migrants have frequently explored their importance in the workforce, but very few have investigated elderly migrants, despite the significant social and health risks they experience. This study, thus, details the health conditions of elderly migrants in Teluk Bintuni Regency, West Papua. Drawing on data from a socio-economic survey conducted between 2015 and 2016, this study analyzes the health of elderly migrants within the context of household conditions, access to health services, income, and education. This study finds that the majority of elderly migrants had experienced some symptoms of illness (headaches, nausea, coughing, etc.) in the last three months. Statistical testing of the above-mentioned variables indicate that elderly migrants' health condition is influenced by their income and access to health services.
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While there is much research on migrant information behavior, the older population tends to be underrepresented in the literature. This article reports on a qualitative study with 16 Chinese older adults (aged 60 and over) who were recent immigrants to Australia and Canada. Migrating late in life presents some unique characteristics and challenges. In both countries, the discourse of “family reunification” frames the experiences of the participants, including their information activities as they learn to navigate the new environment. We used a parallel approach across the two countries to examine these older adults’ information practices as well as the transnational dimension of their settlement process. Findings point to a shared social imaginary as well as daily rituals and coping mechanisms of these late-life immigrants, along with associated information activities. We draw implications for our understanding of this under-studied migrant population, as well as for the design of information support for older migrants as part of their social inclusion in the host country.
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Frailty has recently become a medical category with physical symptoms that define its diagnosis. This paper uses the resources of an ethics of care to analyze the relationship between frailty and fragility or vulnerability, the positives of frailty becoming a diagnostic category, and some problematic aspects of the same process.
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This chapter reports a needs analysis conducted to develop an elementary Chinese course for healthcare professionals. Given that Chinese immigrants became the largest group of new arrivals to the USA in 2013, the communication needs of the Chinese-speaking Limited English Proficiency (LEP) population in various healthcare settings have increased accordingly. A Chinese course for English-speaking healthcare professionals designed to foster their ability to deliver effective healthcare service and raise their intercultural awareness in regard to the target population is, therefore, called for. The study provides a detailed description of the needs analysis for the proposed course. Multiple sources and methods were used during the data-gathering process, which was followed by an analysis to identify the themes and objectives of the course. Ways in which the results can inform the syllabus design and pedagogical development are discussed, and future research directions relating to supporting healthcare professionals’ use of Chinese to communicate effectively with their Chinese-speaking LEP patients are suggested.
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Some subgroups of cancer survivors are more likely to have decreased health-related quality of life (HRQOL) for a prolonged period of time when compared to the average cancer survivor. Research has shown that acculturation can negatively impact the HRQOL of cancer survivors. Research have also shown that Chinese elderly immigrants are generally less acculturated when compared to Chinese immigrants of other age groups. The purpose of this examined the relationship between acculturation and HRQOL among Chinese elderly cancer survivors. Based on the phenomenological approach, a qualitative study consisting of four participants was conducted. Subjects were interviewed using a set of predetermined questions regarding demographics, language ability, social supports, experience with the healthcare system, and general well-being. The results revealed that Chinese elderly who were poorly acculturated had lower social support, experienced more barriers to access healthcare, and experienced more emotional distress. As a result, HRQOL was lower for the less acculturated Chinese elderly cancer survivors compared to those who were better acculturated.
Article
As Chinese immigrants in the United Kingdom age, they experience an increasing need to access health and care services. It has, however, been reported that older Chinese immigrants have difficulties in accessing these services. This study explored the experiences of this population in using health and care services and the strategies that they adopted to address their difficulties. A grounded theory method with a two-staged research design was used. Stage 1 explored the participants' experiences of ageing and use of health and social care services through focus group interviews. Stage 2 investigated the strategies individuals used to support access to and use of services through individual interviews. Forty-four older Chinese people and 15 supporters participated in interviews during August 2011 and May 2013. These older Chinese immigrants were challenged in knowing about and in accessing services. Their difficulties were attributed to language barriers, lack of information and instrumental support, and emotional and cultural issues regarding use of health and care services. Their supporters facilitated access to services and acted as a bridge between the service and the user; therefore, they were given the title 'Bridge People'. Bridge People have different backgrounds: family and friends, public sector workers and staff from community-based Chinese organisations. The defining attributes of these supporters were: bilinguality, bicultural, multifunctionality and accessibility. There is no charge for this support; and the relationship between the Bridge Person and recipient involves trust and influence over decisions regarding use of health and care services. Bridge People should be recognised and identified by health, social care and housing services to promote engagement and use of services by older immigrant Chinese people.
Article
By comparing three groups of Chinese older adults in immigrant, transnational, and nonmigrant families, this study investigated what older adults worry about and whether family relationships and friend network contribute to their worry. Data came from a research project involving 786 Chinese older adults in international migrant families. Analysis of variance, chi-square tests, and hierarchical linear regression were conducted to address the research questions. Statistical results showed that most participants worried about having no one to take care of them when needed. In general, older adults in immigrant families had the highest level of worry. Emotional closeness with adult children was a significant correlate of worry for older adults in all three groups. The association between having some local friends and lower level of worry was significantly stronger among older adults in immigrant families. Our findings indicate practitioners and policymakers should pay special attention to older adults in immigrant families, with a particular focus on promoting emotional closeness with adult children and friend network.
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Engaging disadvantaged communities in health disparities research is recognized as a paradigm shift in increasing the real-world relevance of epidemiological research. Community-based participatory research (CBPR) approach, in particular, has shown great promise in ameliorating behavioral health disparities in the subpopulations who are faced with elevated risks of violence, including child maltreatment, intimate partner violence, and elder abuse. Empirical evidence consistently supported the need for integrating community perspectives in understanding the persistent age, gender, racial, and socio-demographic and economic characteristics of health disparities in violence. However, few CBPR researchers have embarked on the epidemics of the abuse toward older adults, an equally alarming human rights violation. Elder abuse, also referred to as elder mistreatment, affects vulnerable older adults of all backgrounds. With particular attention to elder abuse, this chapter aims to critically review the theoretical and pragmatic rationales of engaging minority communities in health disparities research. We highlight the contribution of CBPR approach in better understanding the epidemiology of elder abuse including prevalence, risk, and protective factors, as well as intervention and prevention strategies, all of which are critically embedded in the social, cultural, and environmental contexts in which elder abuse arises. We summarize researchers’ lessons learned and challenges faced in adopting CBPR principles into the practice of elder abuse research from working with racial and ethnic minority older adults. Moreover, this chapter discusses the significant policy and practice implications in transforming the culture of unilateral academic into collaborative research partnerships with diverse communities. We believe that reflective mutual-learning, or cultural humility, remains the key component in sustaining the impact of research in bringing about social change and health equity.
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Recent scholarship demonstrates how immigrants rely on religion for resources and psychological and social support at various stages of migration. Many studies of religion focus on the institutional role of faith-based organisations, with little regard for the social importance of religious experiences in daily life. Using interviews with U.S. immigrants who identify as Buddhists, I examine how migrants use Buddhist philosophies as a lens for finding meaning in the struggles associated with migration, including language acquisition, employment, and legal status. Through their practice, migrants gain a sense of agency amid vulnerable circumstances. I also explore the potentially negative consequences of the practice’s individual focus, including the propensity to mask structural causes of inequality and impede possibilities for collective action.
Article
Evidence shows that immigrants face several challenges post migration, impacting their social inclusion. Yet, limited scholarly knowledge exists on older immigrants including Tamils from Sri Lanka. Thus, an exploratory concept mapping (CM) study was conducted in 2017 with 27 Tamil immigrant women and men aged ≥55 years and settled in Toronto, Canada. The aim was to gather their perspectives on factors that help them to feel socially included (focal question). The CM methodology first engaged participants in brainstorming sessions to generate ideas in response to the focal question. Participants then joined sorting and rating sessions and sorted 72 generated items and rated them on a scale of 1–5 for importance and feasibility to initiate a change. Finally, in the interpretation session, participants provided feedback on the visual cluster maps generated through quantitative analysis of the collected data. Participants labelled the seven identified clusters: (a) Services for Employment and Settlement; (b) Financial Independence; (c) Medical System and Senior Care; (d) Adaptation and Integration; (e) Family Harmony; (f) Cultural Interaction and Feeling of Security; and (g) Social Interaction. The clusters one to three were at the top for importance (mean 4.33, 4.22, 4.17) and participants interpreted these as needing policy-level attention (e.g. credential evaluation, hiring practices) and identified the roles of advocacy and community-engagement for community-based programmes (CBPs). The Family Harmony was interpreted as needing ‘work within families’, while CBPs’ culturally sensitive outreach was viewed as valuable. Participant interpretation of other clusters highlighted the role of social networking, trust, belonging, civic engagement and social cohesion through joint working of the community members and CBPs. The findings call for an inter-sectoral and community-engaged approach to strengthen the social inclusion of the community. Future research with a larger sample is needed, especially on early settlement experiences and social inclusion of older immigrants.
Article
ABSTARCT Poverty alleviation has long been high on the political agenda of the Chinese government. The current research is intended to evaluate the urban Minimum Livelihood Guarantee Scheme (MLG) scheme, which is serving as the primary anti-poverty policy measure for individuals and families in China. In this article, we construct an evaluation framework, incorporating the concepts of equity, efficiency and effectiveness, which are the most essential factors in the performance evaluation in public sectors. Guided by this framework, a series of indicators were developed to scrutinize the design, implementation and impact of MLG scheme. On the whole, MLG plays an essential role in poverty alleviation among urban residents, however, faced with multifaceted needs of the recipients, urban MLG can only provide them a minimum income, but not guarantee the basic livelihood, especially for those who have to pay for healthcare and children’s education. It is suggested that the government should not limit itself in providing such a mean-tested cash transfer programme, and needy people’s basic livelihood cannot be guaranteed by solely implementing MLG. In addition to MLG, more social assistance programmes such as short-term medical assistance, temporary assistance and educational assistance, both in cash and in kind, are still necessary.
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Objectives: We examined variations in having a usual source of care (USC) among non-Hispanic White and Asian American adults in California. Methods: Data were from the 2005 and 2009 California Health Interview Survey. Using a modified Anderson model, we used multiple logistic regression to compare odds of having a USC between non-Hispanic White (n=38554) and Asian American adults (n=7566) and to examine associations with acculturation factors (English proficiency, length of residence, residence in a racially concordant neighborhood) and key enabling (employment, income, insurance) and predisposing (education) factors. Results: Race-related disparities between Asian Americans and non-Hispanic Whites in having a USC were no longer significant after accounting for acculturation factors. Limited English proficiency and short time in the United States (<5 years) were significantly associated with not having a USC for both races. Increasing levels of education and insurance were not associated with better access among Asian Americans. Conclusions: Key differences exist in how Asian American and non-Hispanic White adults access care. Acculturation factors are key drivers of disparities and should be included in access-to-care models with Asians. Insurance and education are differentially significant for Asian Americans and non-Hispanic Whites.
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In this paper, the health needs and health care utilization patterns of home attendants and their families have been studied as an illustration of those likely to be found among working poor, immigrant women and their children. Despite tremendous growth in the number of immigrants, studies to date provide only limited information regarding the specific health needs and patterns of health care utilization among such women and their children. As part of a longitudinal study on the impact of insurance on health status and health care utilization, 387 female, immigrant home attendants were interviewed. Data were also gathered on 355 of their minor children. These women and children were found to be less likely than other Americans to make use of basic health services, despite the fact that they are more likely to indicate fair or poor health status. This is true even in comparison to poor or uninsured Americans. Immigrant attendants in fair or poor health report an average annual visit rate of 4.1 ambulatory care visits for themselves and 2.2 for their children, as compared to 8.4 for poor adults and 4.4 for poor children in national samples. These findings illustrate the likelihood that poor, immigrant women make limited use of American medical care, and face barriers to health care that appear even greater than those faced by the uninsured and the poor.
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Barriers to access and use of mental health care by Asians, Blacks, and Hispanic Americans have been a source of concern for many years. Limitations in our knowledge base persist regarding patterns of use in public sector programs of certain services. Using a sample of almost 27,000 persons, this study examined access and level of use by ethnic minority groups of emergency services, inpatient care, individual outpatient visit, and case management. Data from the management information systems of San Francisco and Santa Clara counties were analyzed for fiscal year 1987/1988. Multivariate models were evaluated at two stages, reflecting whether or not a service had been used, and if used, the level of use. Asians and Hispanics used less emergency and inpatient but more outpatient care than did Whites; Blacks used more emergency and less outpatient care. Ethnicity continues to play a role in understanding the utilization of mental health services. Regarding emergency and inpatient care, Asian and Hispanic patterns of use appear relatively favorable, whereas the patterns of Blacks continue to be problematic.
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This study aimed to identify the barriers encountered by Chinese people with mental health needs in England which hindered their obtaining appropriate help from the National Health Service (NHS). Attenders at Chinese community centres in health authority districts with resident Chinese population in excess of 2000 were invited to fill in a 12-item Chinese Health Questionnaire (12-CHQ). Individuals who scored two or above, indicating a high probability of a mental health problem, were invited to undertake a semi-structured interview. A total of 401 completed the 12-CHQ. Eighty-six (21.4 per cent) screened positive and 71 (82.6 per cent) agreed to be interviewed. Although 70 (98.6 per cent) were registered with a general practitioner (GP), there were long delays before they made contact with health professionals, and the GP was the first port of call for help in only 27 (38.6 per cent) interviewees. Fifty-two (74.3 per cent) had encountered difficulties when they sought professional help. The main barriers were language, interviewees' perceptions of symptoms as somatic rather than psychiatric in origin, lack of knowledge about statutory services, and lack of access to bilingual health professionals. Doctors, particularly GPs, were pivotal in the management of their conditions. The majority were prescribed psychiatric medication with only a small number in contact with community psychiatric services. Unemployment and social exclusion were common. Stigma associated with mental illness and limited knowledge in the community were identified as the causes for the widespread discrimination experienced by the interviewees. The mental health needs of these Chinese people were not adequately met by statutory services, nor could they rely on family and friends for care and support. Training for health service staff and access to health advocates are essential to maximize the effectiveness of health professional-patient contacts. The promotion of better understanding of mental illness by the Chinese community is important, and greater flexibility within the NHS is required to ensure those professionals with bilingual skills are used to the best effect.
Article
Research on minority elderly service use was examined and patterns of utilization of emergency services, hostpital stays, physicians visits, nursing home placements, and community-based services are described. Although ethnic elders have higher service needs based on medical problems and functional limitations, they have lower utilization rates of the services most important for geriatric populations. Structural and cultural barriers to service utilization are discussed. A framework for service providers is presented which can enable them to address the needs of minority elders for appropriate, accessible, and acceptable geriatric care.
Article
Examines factors affecting health care service utilization by minority (e.g., African American, Asian/Pacific American, Latino) elderly. Problems include minorities' use of emergency rooms for primary care, inferior treatment despite equal doctor visits, underuse of hospitals and community-based services, and underestimation of needs for external support due to cultural expectations for family care provision. Structural (external) barriers to service delivery, such as racism, and cultural (internal) barriers, such as family dynamics and cultural bias, are examined. Cultural barriers have been related to ethnic identity, acculturation, and ethnic attitudes, such as fatalism and an external locus of control. Services need to be suited to ethnic elders' levels of functioning and congruent with ethnic expectations. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This study examines help seeking and utilization patterns of 161 Asian or Pacific Islander Americans and 1332 White Americans randomly selected in the Los Angeles area, based on the first wave of the Epidemiological Catchment Area (ECA) study. Logistic regression analyses are performed to detect ethnic differences in disclosing mental health problems and utilizing mental health services. Results show that Asian Americans are more reticent than White Americans about mental distress regardless of whether they speak with professionals or family and friends, and that they are unwilling to use mental health services of any type. However, contrary to common assumptions, Asian Americans claim somatic discomfort as frequently as White Americans do, and the somatic discomfort is independent of Asian Americans' unwillingness to talk about mental health problems. © 1998 John Wiley & Sons, Inc.
Article
A major challenge in the United States is to narrow the gap in the excess morbidity and mortality rates of minority populations. This article presents a synthesis of the 15-year results of a collaborative program between the Johns Hopkins Medical Institutions and an African-American community with the highest rates of premature disease and death in Maryland. The program began with an efficacious disease prevention clinical trial with patients and ended with effective population approaches. We transferred key components to community ownership and formally trained community health workers who provided health promotion counseling, monitoring, linkage, and referral services. Results indicated significant decreases in morbidity and mortality as a result of improved control of hypertension. This program has begun to decrease the health status gap in an African-American population and has demonstrated long-term sustainability. Current joint activities are directed at several major causes of excess morbidity and mortality, including smoking, obesity, hyperlipidemia, and hypertension, and at plans for programs to control diabetes, substance abuse, and breast and cervical cancer.
Article
Differences in psychopathology and use of the mental health system by recent refugee groups are explored in light of competing hypotheses stemming from theories of immigrant adaptation and minority mental health. Results show that would-be Haitian refugees arriving in South Florida during the early 1980s had relatively small needs for mental health care, but whatever needs they had were largely unattended by the health services system. Mariel Cubans had far greater needs that were mostly met satisfactorily by virtue of their familiarity with service facilities prior to departure and their incorporation into a favorable social environment. These contextual factors are added and compared with the individual-level predictor variables suggested by Andersen and others. The results' implications for theories of immigrant mental health and help-seeking and for the implementation of effective delivery programs are discussed.
Article
Investigated the help-seeking behavior and attitude regarding psychological problems as mediated by mental health status, acculturation level, and sociodemographic characteristics in a community sample of Chinese Americans. Of the 128 respondents, 17 (13.3%) had consulted professional help for a nervous or emotional problem. Compared to the others, they reported significantly poorer mental health status (i.e., had more physical symptoms, had once come close to experiencing a "nervous breakdown," and had a relative who had been in treatment), and were more likely to be American-born. For those who had not previously sought help, attitude toward help seeking was examined. A positive attitude was mediated by superior English ability, being younger, married, and from a lower SES background. The findings suggested help-seeking behavior is primarily mediated by presence of need, whereas attitude reflected a general propensity. Acculturation was an important predictor of both behavior and attitude, with the less acculturated most in need of education about the utility of mental health service.
Article
In this article the utilization of medical services by Indochinese refugees is examined. A representative sample of the refugee population in one resettlement site provides basic data on health service utilization behaviors. The analysis focuses on the situational and attitudinal determinants of hospital contact, physician contact, and the volume of utilization of both services. The findings indicate that length of residence and ethnicity are important predictors of utilization behaviors. The most recently arrived refugees and the Hmong are low utilizers of physician and hospital services. A regression analysis of situational and attitudinal variables shows that effects of length of residence and ethnicity do not diminish when the effects of the other variables are considered. Although the results are similar to previous utilization studies, they do suggest that Indochinese refugees require more information about United States health services to utilize them properly.
Article
The purpose of this paper is to disseminate some of the findings from the 1979 National Ambulatory Medical Care Survey (NAMCS) where, for the first time in its history, data are available on the characteristics of visits to office-based physicians by Asian/Pacific Americans. The NAMCS Program is the only source for such data which is based on a national probability sample survey of physician-patient encounters. Among the findings are: 1) no significant difference was observed between Asian/Pacific Islanders and the white majority with regard to the patient's sex, return-visit ratio, or the kinds of diagnostic and therapeutic services rendered by the sampled physicians. 2) Children appear to be the major utilizers of ambulatory medical care among Asian/Pacific Americans. 3) In every age group, the visit rate to office-based physicians is lower for Asian/Pacific Americans when compared with white Americans. 4) A significantly smaller percentage of Asians or Pacific Islanders, in contrast to other specified race/ethnic groups, had visited a physician for injury or poisoning, and a substantial proportion of their visits were apparently made for preventive care. 5) Significantly fewer visits were made by Asian/Pacific Americans to the office of a surgeon or a psychiatrist. The demographic antecedents and cultural underpinnings of these findings are discussed.
Article
The Behavioral Model of Health Services Use was initially developed over 25 years ago. In the interim it has been subject to considerable application, reprobation, and alteration. I review its development and assess its continued relevance.
Article
We use the 1990 National Health Interview Survey supplement on Family Resources to examine the health care utilization patterns of immigrant and native-born adults in the United States. We modify a standard health care utilization framework by including duration of residence in the United States and measures of immigrant adaptation and family health context to model both the probability and number of physician contacts in the previous year. We find that duration of residence has a strong effect. Recently-arrived immigrants are much less likely to have had a contact in the previous year and had fewer contacts than either native-born or longer-term immigrant adults. Once the measures of adaptation--age at immigration and language of survey interview--are included, immigrants who have been in the United States for 10 years or more are not statistically different from the native-born. Family characteristics, including measures of exposure to the formal health care system, slightly reduce the size of the effects but do not alter the basic relationship between duration of residence and health care utilization. These results suggest that, net of socioeconomic characteristics, access to health insurance, and differences in morbidity, recent immigrants are much less likely than both the native-born and those immigrants of longer duration, to receive timely health care.
Article
What are the barriers to good health care for immigrants who have come to the Minneapolis-St. Paul metropolitan area since the early 1980s? Why do immigrants often delay or avoid seeking mainstream health care services? The research described here examines these questions from the perspective of nonimmigrant health care providers in the Twin Cities. The 24 metropolitan health care providers interviewed in our study confirmed the existence of significant barriers to health care-barriers that probably differ from those experienced by nonimmigrant patients. Refugees and immigrants from other cultures had varying culturally based reactions to Western-style, allopathic medicine-some positive and many negative. Providers and administrators must consider these barriers when serving a growing population of immigrant patients.
Article
Birch and Abelson [1] argue that non-income based barriers might explain differences in utilization of health services within and between income groups. Databases which contain utilization data rarely allow for the modelling of geographic variation. In the Ontario Health Survey (OHS), individual observations are georeferenced at the Public Health Unit (PHU) scale, but PHUs cannot easily be used because of the large coefficients of variation. To overcome this problem, a cluster analysis is performed to create a service environment variable, which reflects differences in service availability, population size and rurality. Utilization of health services is then modelled as a logistic regression equation where the independent variables are age, sex, service environment and income to test the Birch and Abelson argument. This argument is then extended by controlling for age, health and income status. Based on the modelling results, the importance of geography to access and utilization is assessed.
Article
Some have speculated that underutilization of Western health services among non-Western populations can be explained by traditional health beliefs and practices rooted deep within cultures. These beliefs and practices may act as barriers to access to and utilization of services. Among Vietnamese, in particular, a number of traditional health beliefs and practices have been identified which are said to pose barriers to Western medical care. No studies to date, however, have examined this hypothesis empirically. To examine this hypothesis, we measured traditional health beliefs and practices among Vietnamese in the San Francisco Bay area and analyzed the relationships between these factors and access to health care and use of preventive health services. The results of this study show clearly that many Vietnamese possess traditional health beliefs and practices which differ from those of the general U.S. population. Yet, the data do not support the hypothesis that these traditional beliefs and practices act as barriers to access to Western medical care or to utilization of preventive services. Being married and poverty status were the most consistent predictors of health care access. Furthermore, the components of access to health care (having some form of health insurance or having a regular doctor, for example) were the strongest predictors of preventive health care services utilization. Importantly, the cultural attributes of individuals did not explain either lack of health care access or underutilization of preventive health care services.
Article
Despite an increase in the population of elderly Chinese immigrants, little is known about their mental health problems. The most prevalent mental health problem of elderly people-depression-often goes unrecognized and untreated. In an interview format, the author administered the Geriatric Depression Scale and measures of health status, living situation, stressful life events, and informal support to a community sample of 50 elderly Chinese immigrants recruited at senior centers and meal sites. Respondents who rated their health as good, who lived with others, and who were satisfied with help received from family members were least likely to be depressed. The impact of these factors on the mental health of elderly Chinese immigrants can be understood in light of their unique cultural values.
Article
The purpose of this study was to describe the mental health beliefs and practices of Chinese American immigrant women. A two-part design using both qualitative and quantitative techniques was employed. The first step utilized focus group (n = 14) and key informant (n = 2) interviews to discover the beliefs, practices, and knowledge about mental health of this population. Content analysis was used to examine and condense the qualitative data. After completion of the qualitative component, 72 women were recruited to complete a set of questionnaires, which included a demographic questionnaire, culture and work subscale, and the mental health portion of the Health Behavior Scale of the Survey of Chinese American Mental Health (NRCAAMH, 1993). Pearson product-moment correlations and regression analysis were used to analyze the quantitative data. Content analysis found that the cultural value placed on the avoidance of shame, pragmatism that results in the use of both Western and traditional Chinese practitioners and treatments, and the inadequacy of Western-type services to meet the needs of the Chinese American immigrant population act as barriers to utilization of these services. These results are cross-validated by the quantitative findings. The importance of culture in determining the pathway to care was supported by the finding that higher levels of acculturation are related to greater use of mental health services.
Article
This article reports the results of a randomly administered interview of 1,808 Chinese American residents of San Francisco. The study examines income, language, and citizenship status and their effect on the use of health care services by this population. The articles discusses the implications of the findings for low-income and uninsured individuals, particularly people of immigrant status, and concludes with suggestions for local health care planners and advocates.
Article
There is increasing demand for measurement tools to assess health related quality of life among the Chinese elderly population in the United States. Health services questionnaires, developed largely in English, often under-represent Chinese Americans. Based on conventional mortality statistics, the public mistakenly views Chinese Americans as a "model" minority with no health problems. This general perception has masked the serious health problems among the elderly Chinese Americans. Using the newly developed Chinese version of the MOS SF-36, we aim to explore how elderly Chinese perceive their own health. Based on 219 elderly Chinese recruited in Boston, the study provided mixed results with regard to the perception of a healthy minority model. While the study subjects perceived similar or better physical health to the U.S. norm, they reported worse mental health than the U.S. norm. We explored possible explanations for this discrepancy and discussed the implications as well as directions for future research.
Article
This study identifies whether culturally based differences in perceptions of health resulted in differences in ambulatory care use among the elderly. METHODS. The authors conducted stratified Poisson regressions on data from a 1992 survey of older Koreans and Whites in Los Angeles County. The models included measures of demographics, health, functioning, income, insurance, social support, and culture (perceptions of health or other beliefs). RESULTS. Descriptive findings showed older Koreans had more ambulatory physician visits, poorer functioning, and poorer perceptions of their health than Whites. Multivariate findings showed that positive perceptions of health independently reduced office visits for both Koreans and Whites, but the effect was significantly smaller for Koreans. Other cultural differences also affected use. DISCUSSION. The findings highlight differences between older Koreans and Whites' responses to physical and socioeconomic conditions and the importance of cultural sensitivity in the health care delivery system.
Article
This study examines access to medical care for Asians and Pacific Islanders in the United States, using a survey of patients receiving care provided by a physician group practice association concentrated on the West Coast. Asians and Pacific Islanders who had used their health plan in the past year had worse access to health care than whites, blacks, Hispanics, and Native American or other ethnicities. The odds that Asians reported that they had adequate access ranged from about one quarter to three quarters that of whites, depending on the measure. Cultural differences and associated communication problems may explain the access problems experienced by Asians. Interventions need to be developed to address the problems with access to services, and better translation services may play an important role in improving access to care for Asians. Future studies need to clarify why Asians were more vulnerable to the access problems examined than other ethnic groups that might experience similar barriers.
Article
This study examined the extent to which cultural, socioeconomic, and systemic factors impeded access to and utilization of health services among a convenience sample of 52 Chinese immigrants living in metropolitan Houston. The subjects, of differing levels of socioeconomic status, were 25 years old or older. Methods used for data collection included participant observation, face-to-face interview, and case study. A semistructured interview instrument with open- and closed-ended questions was administered. A pilot study and expert reviews were conducted for content and face validity. Cultural and socioeconomic factors were found to be strongly associated with access to and utilization of health services. Mainland Chinese and Taiwanese shared similar cultural dilemmas as they sought health care, including communication difficulties, beliefs about health, health care, and illness, and mistrust in Western health care. Although families played important roles in health decisions and choices of services, social class differences also appeared to affect utilization. For example, more affluent Taiwanese than Mainland Chinese were apt to carry health insurance and use Western systems. The findings suggest a need to improve services to the Chinese community through family-centered and community-based approaches adapted to Chinese culture.
Article
To explore factors that affect health and social service use among elderly Russian immigrants from the perspectives of the elders, their adult caregiving children, and the health and social service professionals who serve them. A qualitative, case-oriented study design was used and 17 elderly Russian immigrants, 8 adult caregiving children, and 15 health professionals were interviewed in the Boston area in 1998. Perceptions about the patterns of and reasons for Russian elders' health and social service use were summarized through content analysis of the interview data. Participants across groups perceived extensive service use by elderly Russian immigrants. Life circumstances associated with immigration, cultural norms and beliefs, and structural characteristics of the local Russian immigrant community accounted for service use. Findings indicate that providing support for depression and loneliness associated with immigration, educating immigrants about the role of primary care providers in the US as well as realistic expectations for American medicine, and managing care to decrease the use of unnecessary services would facilitate appropriate service use among elderly Russian immigrants.
Article
PURPOSE. The purpose of this study is to review the literature to synthesize empirical health services research on Asian and Pacific Islander American (APIA) populations. Health studies of APIA are summarized using the Behavioral Model of Health Care Utilization, which has been expanded for racial and ethnic groups. METHODS. The MEDLINE databases from 1980 to 1994 were searched for all studies focusing on APIA populations using selected key words. In addition, we searched for comparative studies of APIA with other ethnic groups. Screened studies were assigned codes based on the expanded Behavioral Model using information contained in the abstracts. PRINCIPAL FINDINGS. Although the _number_ of studies that have been published on APIA populations have increased over the past 15 years, the _proportion_ of studies that focus on specific subgroups of the population has decreased. The populations that are most understudied relative to their size are Koreans and Filipinos. Most of the studies included population characteristics and evaluated/clinical outcomes, while studies of preceived and consumer satisfaction outcomes were relatively infrequent. CONCLUSIONS. Given the rapid growth of the APIA population, this group is underrepresented in the published work. Studies are needed that determine cultural influences on health status and outcomes of the health care system for ethnic subgrups of the APIA population. KEY WORDS. Asian Americans; Pacific Islanders; Behavioral Model; Asian Indian; Cambodian; Chinese; Filipino; Guamanian; Hawaiian; Hmong; Indochinese, Japanese, Koreans, Laos; Laotian; Samoan; Southeast Asian; Thai; and Vietnamese.
Article
To assess general practitioner consultation among Chinese people compared with the general population and other minority ethnic groups, and to investigate the factors associated with general practitioner consultation among the Chinese population. Survey of a representative sample of Chinese people aged 16-74 living in private households in metropolitan areas of England. One thousand and twenty-two people who defined themselves as 'of Chinese origin' were interviewed. General practitioner consultations were analysed in relation to self-reported general health and long-standing illness or disability, gender, age, social class, country of birth, whether the respondent spoke English, use of traditional Chinese medicine, and the ethnicity and gender of the respondent's general practitioner. The self-reported general health status of Chinese people is similar to that of the general population and better than that of other minority ethnic populations. The level of general practitioner consultation by Chinese people is low compared with the general population and with other minority ethnic groups. Within the Chinese population, general practitioner consultation is related to gender, self-reported health status and the ability to speak English. Ability to speak English is the strongest positive predictor of general practitioner consultations. Chinese people in England are less likely than people from other minority ethnic groups to consult their general practitioner, even after their relative health status is taken into consideration. Use of general practitioners by Chinese people in England is associated with a number of factors, of which the strongest predictor is the ability to speak English. Chinese people who speak English are more likely than those who do not, to consult their general practitioner. Health service providers should accommodate the needs of this group by providing access to advocacy services.
Article
The purpose of this study is to outline a method to identify the characteristics of socioeconomic variables in determining the differences in health insurance coverage and health services utilization patterns for different ethnic groups, using the behavioural model of health service utilization. A sample drawn from Asian American adult respondents to the 1992, 1993, and 1994 National Health Interview Surveys (NHIS) in the USA formed the data set. The results showed Asian Americans as not being homogeneous. There were distinctly different demographic and socioeconomic characteristics between six Asian American ethnic groups that affect health insurance coverage and health service utilization. The study method is useful for constructing health policy and services to address the general public need without adversely affecting smaller minority groups. Secondary analysis of well-constructed national data sets such as the specific Asian ethnic groups in NHIS, offers a rich method for predicting the differential impact of specific health policies on various ethnic groups.
Article
The purpose of this article is to describe the theoretical models that underlie the book Cultural Diversity in Health and Illness. The book's internal structure; functional structure; conceptual relationships; scope; knowledge antecedents; applications to theory, research, and practice; and areas for further development are discussed.
Asian Canadians consistently underutilize mainstream mental health services. This study investigates how the definition and meaning of mental illness relates to barriers Asian Canadians find in accessing mental health services. Personal interviews were conducted with 60 Asian Canadians in a northern community in the province of British Columbia. Content analyses revealed six themes that defined a mental health problem: (a) feeling a lack of purpose in life, (b) feeling lonely, (c) difficulties understanding and dealing with a new environment, (d) high anxiety levels, (e) descriptions of mental health problems as somatic illnesses, and (f) perceptions of mental illness as serious and potentially not treatable. It was also found that poor English language ability and a lack of understanding of mainstream culture were major barriers to accessing mental health facilities. Findings of this study provided valuable insights concerning Asian immigrants' hesitancy accessing and utilizing mainstream mental health facilities. The many poignant personal anecdotes illustrate that the migration and adaptation processes can be painful and full of anguish. Unless their experiences are better understood and accepted, many Asian Canadians will likely remain outside of the available mainstream mental health facilities.
Article
The health care services and sociodemographic profiles of Chinese women residing in each of five neighborhoods of Vancouver and Richmond, British Columbia, were examined and compared to Pap testing rates. Information was collected from the provincial medical directory, the cervical cancer screening program, and a community-based survey. A total of 159 Chinese primary care physicians, 3 Chinese gynecologists, and 9 health clinics were identified within these neighborhoods and 769 Chinese women responded to the survey. Significant differences were found between neighborhoods in Pap testing rates, with Chinatown having the lowest rates. Differences between neighborhoods were also found in the availability of Chinese language health care services, sociodemographic profiles of the Chinese population, individual preferences and experiences with health care services, which were also related to Pap testing rates. The implications of these findings upon the planning of effective health care services within local neighborhoods are discussed.
Article
The purpose of this qualitative study was to explore arthritis management strategies among Chinese immigrants in Calgary, Canada, and to assess factors, that impact on these strategies. Purposive sampling was used to select 19 Chinese immigrants living with arthritis. Data were collected by means of in-depth interviews. The interview data were analyzed according to the following steps: (1). transcribing interview materials, (2). developing codes, categories and themes, (3). theoretical coding, and (4). laying out the theoretical framework. The results of this study describe factors, that impacted on illness management strategies. These include arthritic symptoms, beliefs about arthritis, beliefs about Western medicine based on treatment experience, beliefs about Chinese medicine, perceived barriers to using Chinese or Western medicine and social support. The emerging process of illness management shows that immigrants usually started using self-care remedies, followed by consulting Western physicians, consulting Chinese healers, and then returning to Western medicine. The results illustrate that disease management strategies among Chinese immigrants are impacted by disease, personal and cultural factors. These factors suggest helpful directions to providing culturally sensitive care, which can lead to greater satisfaction and well being for Chinese immigrants with arthritis.
Supplementing informal care of frail elders with formal services: A comparison of White, Hispanic, and Asian non-spouse caregivers
  • B Wu
Wu, B. (2000). Supplementing informal care of frail elders with formal services: A comparison of White, Hispanic, and Asian non-spouse caregivers. Unpublished doctoral dissertation, University of Massachusetts, Boston.
Perceptions of health and use of ambulatory care: Differences between Korean and White elderly
  • N Pourat
  • J Lubben
  • H Yu
  • S Wallace
Pourat, N., Lubben, J., Yu, H., & Wallace, S. (2000). Perceptions of health and use of ambulatory care: Differences between Korean and White elderly. Journal of Aging and Health, 12,112–134.