Health literacy issues in the care of Chinese American immigrants with diabetes: a qualitative study

Understanding Elderly Chinese Cancer Patients in a Multicultural Clinical Setting: Embracing Mortality and Addressing Misperceptions of Vulnerability

Chinese patients face higher risks of gastrointestinal (GI) cancers and greater cancer-related deaths than Canadian-born patients. The older population encounters barriers to quality healthcare, impacting their well-being and survival. Previous studies highlighted Chinese immigrant perceptions of not requiring healthcare support. During the COVID-19 pandemic, their underutilization of healthcare services garnered attention. The present study explores the experiences of older Chinese cancer patients to improve culturally sensitive cancer care. A total of twenty interviews carried out in Cantonese and Mandarin were conducted with Chinese immigrants, aged 60 or above, diagnosed with Stage 3 or 4 GI cancer. These interviews were transcribed verbatim, translated, and subjected to qualitative descriptive analysis. Among older Chinese immigrant patients, a phenomenon termed "Premature Acceptance: Normalizing Death and Dying" was observed. This involved four key themes: 1. acceptance and letting go, 2. family first, 3. self-sufficiency, and 4. barriers to supportive care. Participants displayed an early acceptance of their own mortality, prioritizing family prosperity over their own quality of life. Older Chinese patients normalize the reality of facing death amidst cancer. They adopt a pragmatic outlook, acknowledging life-saving treatments while willingly sacrificing their own support needs to ease family burdens. Efforts to enhance health literacy require culturally sensitive programs tailored to address language barriers and differing values among this population. A strengths-based approach emphasizing family support and practical aspects of care may help build resilience and improve symptom management, thereby enhancing their engagement with healthcare services.

Addressing COVID-19 Vaccine Hesitancy and Uptake Among African Immigrants: Lessons from a Community-Based Outreach Program

In 2021, the African Cultural Alliance of North America (ACANA) implemented a community-based vaccine education and outreach program to decrease hesitancy and increase COVID-19 vaccine uptake among African immigrants in Philadelphia. The program had three components: (1) tailored messaging on the benefits of vaccines by trusted community health navigators in familiar languages/dialects, (2) use of educational/tabling events, and (3) establishment of a vaccine clinic in community settings. Using secondary data analysis, in-depth interviews, focus group discussions and a self-administered survey, we explored (i) the impact and effectiveness of the outreach program and extent of vaccine uptake, (ii) African immigrants' beliefs about the COVID-19 pandemic and the vaccine, and (iii) barriers and facilitators of vaccine knowledge, uptake, and hesitancy. Our analysis showed that ACANA's outreach program was effective in addressing several cultural, logistic, and systematic barriers to vaccine uptake. The program distributed 2000 educational/informational flyers, reached 3000 community members via social media campaigns, and an additional 2320 through other person-to-person outreach events. The program was effective and resulted in the vaccination of 1265 community members over the course of the outreach. The impact of this outreach underscores the critical role of community-based organizations in addressing COVID-19 vaccine hesitancy and increasing vaccine uptake in underserved and minority communities. The paper concludes with suggestions and recommendations for using community-based outreach programs to increase COVID-19 vaccine uptake and decrease hesitancy.

Cultural influences on shared decision-making among Asian Americans: A systematic review and meta-synthesis of qualitative studies

OBJECTIVE

To summarize how Asian Americans negotiate involvement in shared decision-making (SDM) with their providers, the cultural influences on SDM, and perceived barriers and facilitators to SDM.

METHODS

This is a systematic review of qualitative studies. We searched six electronic databases and sources of gray literature until March 2021. Two reviewers independently screened studies, performed quality appraisal, and data extraction. Meta-synthesis was performed to summarize themes using a three-step approach.

RESULTS

Twenty studies with 675 participants were included. We abstracted 275 initial codes and grouped these into 19 subthemes and 4 major themes: (1) negotiating power and differing expectations in SDM; (2) cultural influences on SDM; (3) importance of social support in SDM; and (4) supportive factors for facilitating SDM.

CONCLUSIONS

Asian Americans have important perspectives, needs, and preferences regarding SDM that impacts how they engage with the provider on medical decisions and their perception of the quality of their care.

PRACTICE IMPLICATIONS

Asian American patients valued good communication and sufficient time with their provider, and that it is important for health professionals to understand patients' desired level of involvement in the SDM process and in the final decision, and who should be involved in SDM beyond the patient.

OTHER

This systematic review was registered on PROSPERO (CRD42021241665).

The development and validation of Chinese Health Literacy Scale (CHLS) for older people

OBJECTIVES

We tried to develop a more concise health literacy scale for Chinese older adults.

METHODS

A draft scale based on the Health Literacy Questionnaire (HLQ) was developed, and revised by experts. We conducted a pilot study to test the readability and establish a standard inquiry method within 10 residents. We tested the validity and internal consistency using a field test with 3,739 participants.

RESULTS

Overall standardized Cronbach's α of Chinese Health Literacy Scale (CHLS) was 0.86 and that of each dimension ranged from 0.69 to 0.81. Nearly all dimensions had satisfactory factor loadings (0.33-0.98). The correlation coefficient between the score of each item and its dimension ranged from 0.59 to 0.92.

CONCLUSIONS

The performance of CHLS was almost the same as the HLQ but more concise. It might play a role in reflecting the health literacy of older adults in China and further promoting their health.

Older Korean Americans' Perceived Burdensomeness to Their Healthcare Partners: An Egocentric Network Assessment

Objectives: The objective is to examine how older Korean Americans' perceived burdensomeness to their healthcare partners is associated with the characteristics of older adult participants (egos) and their healthcare partners (alters). Methods:Surveys of 2150 participants in the Study of Older Korean Americans provided ego data. Participants were also asked to list up to three individuals whom they usually asked for help on health-related matters or healthcare use, which generated 3402 alters. Multilevel modeling was conducted to examine the role of the characteristics of egos and alters, as well as their cross-level interactions. Results: Perceived burdensomeness was negatively associated with English-speaking ability and residence in a low Korean density area. Perceived burden was also lowered when emotional support was received from the alters, and this pattern was pronounced among those with multi-comorbidity. Discussion: By identifying older immigrants prone to the sense of burdensomeness, the study suggests strategies to promote their health and healthcare use.

Patients’ and Nurses’ Perceptions of Diabetes Self-Management in Oman: A Qualitative Study

Patient-centered care enhances diabetes self-management; however, the primary care nurse’s role in promoting diabetes self-management within a patient-centered care model is unexplored. This study investigated the perceptions of Omani patients with type-2 diabetes and their clinic nurses on the nurses’ role in promoting diabetes self-management within a patient-centered care approach. The thematic analysis of the data from individual interviews with patients (n = 24) revealed two themes: patients experienced “missteps on an unclear path” and “nurses doing their best.” Patients struggled to identify treatment goals and faltered in their attempts to adopt diabetes self-management behaviors. The nurses’ role was perceived as task-oriented. Nurse narratives (n = 21) revealed that very few nurses were aware of the patient-centered care philosophy. A theme emerged of nurses “needing a new perspective” to transition their care delivery to align with the patient-centered care model. Nurses expected patients to comply with their instructions and missed opportunities for assessment, engagement, and collaborative problem-solving during patient encounters. The shift from a physician-based medical model to a patient-centered primary care delivery system may necessitate that nurses engage more effectively with patients, collaborate on an individual treatment plan, and motivate them to adopt self-management behaviors.

OUP accepted manuscript

Objective

The COVID-19 pandemic has seen a rapid adoption of telehealth consultations, potentially creating new barriers to healthcare access for racial/ethnic minorities. This systematic review explored the use of telehealth consultations for people from racial/ethnic minority populations in relation to health outcomes, access to care, implementation facilitators and barriers, and satisfaction with care.

Materials and Methods

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the Joanna Briggs Institute Manual for Evidence Synthesis. Five major databases were searched to identify relevant studies. Screening, full-text review, quality appraisal, and data extraction were all completed independently and in duplicate. A convergent integrated approach to data synthesis was applied with findings reported narratively.

Results

A total of 28 studies met the inclusion criteria. Telehealth-delivered interventions were mostly effective for the treatment/management of physical and mental health conditions including depression, diabetes, and hypertension. In several studies, telehealth improved access to care by providing financial and time benefits to patients. Technological difficulties were the main barriers to effective telehealth consultation, although overall satisfaction with telehealth-delivered care was high.

Discussion

Telehealth-delivered care for racial/ethnic minorities offers promise across a range of conditions and outcomes, particularly when delivered in the patient’s preferred language. However, telehealth may be problematic for some due to cost and limited digital and health literacy.

Conclusion

The development and implementation of guidelines, policies, and practices in relation to telehealth consultations for racial/ethnic minorities should consider the barriers and facilitators identified in this review to ensure existing health disparities are not exacerbated.

Mammography Screening Disparities in Asian American Women: Findings From the California Health Interview Survey 2015-2016

PURPOSE

To identify mammography screening prevalence and predictors in Asian American women, focusing on the potential disparities in race and its influence on screening behaviors.

DESIGN

A secondary analysis utilized the California Health Interview Survey (CHIS) 2015-2016.

SETTING

California, U.S.

SAMPLE

Cisgender women who were non-Hispanic (NH) White, Chinese, Filipino, Vietnamese, Japanese, Korean, or "other Asian", aged 40 or above (unweighted N=13 451).

MEASURES

Socioeconomics, chronic health conditions, and preventive care utilization were mesuared as potential risk factors, where up-to-date mammography screening as the outcome variable.

ANALYSIS

Multivariable adjusted logistic regressions were generalized to identify the up-to-date mammography screening behaviors in relation to potential factors, stratified by race and ethnicity.

RESULTS

The prevalence for up-to-date mammography screening in NH-White and Asian American women were 68.06% and 65.97%, respectively. In NH-White women, receiving an up-to-date mammogram was associated with age, birthplace, smoking status, diabetes, hypertension, health insurance coverage, and a preventive care visit in the past 12 months, whereas only age and a preventive care visit were significant predictors in Asian women.

CONCLUSIONS

The findings indicate that utilization disparities exist in mammogram in relation to socioeconomics, chronic health conditions, preventive care utilization, when comparing between race and ethnicity. Asian American women with borderline hypertension and no preventive care visits may require more public health outreach and cancer education.

Chronic Illness Management in Culturally and Linguistically Diverse Patients: Exploring the Needs, Access, and Understanding of Information

In Canada, people from culturally and linguistically diverse (CALD) backgrounds are at a greater risk of developing a chronic illness, and are more likely to experience adverse health effects and challenges in accessing high-quality care compared with Canadian-born individuals. This, in part, has been attributed to having inadequate access to information and resources needed to manage their illness(es). A qualitative descriptive design and inductive content analysis were used to explore the information needs of 24 CALD patients with chronic illnesses. Participants identified medical, lifestyle, and psychosocial information needs. How much information was needed depended on such antecedents as illness trajectory, severity, and perception. Most information needs remained unmet. A number of communication strategies were identified to bridge language barriers that go beyond translation and are based on effective health education strategies. Findings can help health care professionals better identify CALD patients' information needs and provide strategies that go beyond translation.

HPV vaccination, information sources, and acculturation among Chinese college students aged 18-26 in the United States

Human papillomavirus (HPV) vaccination behaviors among Chinese college students (CCS) in the United States are affected by social determinants of health. Using a self-report questionnaire and a snowball sampling technique, this cross-sectional study investigated (a) HPV vaccination practices; (b) primary social networking platforms and preferred means of receiving HPV information; and (c) the influence of acculturation on HPV vaccination, HPV information sources, and social networking use among 213 CCS aged 18-26 in the United States. About half (50.7%) had received one to three doses of an HPV vaccine, and 91.7% had received their first dose. The most popular social networking platforms were WeChat (69.5%), Instagram (58.7%), text messaging (55.4%), and Facebook (47.4%). Preferred means of receiving future HPV information included the internet, online social networking, and health professionals. Participants with high Asian identification (AI) were less likely to receive the HPV vaccine than those with high Western identification. Participants with high AI were more likely to use WeChat for their social networking but less likely to use US-based social media platforms. Acculturation, preferred social networking platforms, and sources and communication of HPV (i.e., health professionals, family members, schoolteachers, friends) influenced participants' HPV vaccination. To promote equity of access to health messages and increase HPV vaccination, future efforts should pay attention to CCS with high AI and incorporate their cultural beliefs and practices. Given that nonprofessionals (e.g., family, friends) were influential factors in HPV vaccination, it is critical to tailor interventions for CCS to the recipients and their social circles.

Health Literacy Within a Diverse Community-Based Cohort: The Multi-Ethnic Study of Atherosclerosis

BACKGROUND

Health literacy has yet to be described in a non-clinical, racially diverse, community-based cohort.

METHODS

Four questions assessing health literacy were asked during annual phone encounters with Multi-Ethnic Study of Atherosclerosis (MESA) participants between 2016 and 2018 (n = 3629). We used prevalence ratios (PRs) with 95% confidence intervals (CIs) to characterize how demographic and acculturation factors related to limited health literacy. Models adjusted for age, sex, and race/ethnicity, and race/ethnicity-stratified models were also examined.

RESULTS

Limited health literacy was prevalent in 15.4% of the sample. Participants who were older, female, lower-income, or less acculturated were at greater risk for having limited health literacy. Chinese, Hispanic, and Black participants were more likely than White participants to have limited health literacy. Patterns were similar when stratified by race/ethnicity.

DISCUSSION

Within MESA limited health literacy was common, particularly among Chinese and Hispanic participants, with some of the variance explained by differences in acculturation.

A qualitative exploration of enablers for hepatitis B clinical management among ethnic Chinese in Australia

An estimated 18% of people living with chronic hepatitis B (CHB) in Australia were born in China. While guideline-based care, including regular clinical monitoring and timely treatment, prevent CHB-related cirrhosis, cancer and deaths, over three-quarters of people with CHB do not receive guideline-based care in Australia. This qualitative study aimed to identify enablers to engagement in CHB clinical management among ethnic Chinese people attending specialist care. Participants self-identified as of Chinese ethnicity and who attended specialist care for CHB clinical management were interviewed in Melbourne in 2019 (n = 30). Semi-structured interviews covered experiences of diagnosis and engagement in clinical management services, and advice for people living with CHB. Interviews were recorded with consent; data were transcribed verbatim and thematically analysed. Receiving clear information about the availability of treatment and/or the necessity of long-term clinical management were the main enablers for participants to engage in CHB clinical management. Additional enablers identified to maintain regular clinical monitoring included understanding CHB increases risks of cirrhosis and liver cancer, using viral load indicators to visualize disease status in patient-doctor communication; expectations from family, peer group and medical professionals; use of a patient recall system; availability of interpreters or multilingual doctors; and largely subsidized healthcare services. In conclusion, to support people attending clinical management for CHB, a holistic response from community, healthcare providers and the public health sector is required. There are needs for public health programmes directed to communicate (i) CHB-related complications; (ii) availability of effective and cheap treatment; and that (iii) long-term engagement with clinical management and its benefits.

A psychometric evaluation of the Health Literacy Questionnaire for Chinese immigrants: Linguistic and cultural considerations

OBJECTIVE

Health literacy is an important predictor of health outcomes. The Health Literacy Questionnaire has been widely adopted to measure health literacy and has been translated into multiple languages including Chinese. This study aims to evaluate the psychometric properties of the simplified Chinese Health Literacy Questionnaire.

METHODS

Data were obtained from a sample of 362 Chinese immigrants from Chinese community organizations in New South Wales, Australia. Statistical analyses include descriptive and exploratory factor analyses.

RESULTS

A seven-factor solution was derived from 39 of the original 44 items, all with acceptable to excellent internal consistency but differing from the original construction. The health literacy subscale scores were negatively associated with age and with age at immigration, but positively associated with duration of stay (years) in Australia, better English proficiency and current employment. Differing interpretations of the questions based on Chinese culture could possibly explain the variations between the two versions.

CONCLUSION

The simplified Chinese Health Literacy Questionnaire measures some central concepts of health literacy well. However, the questionnaire may require further development, especially in linguistic and cultural aspects.

Moving Diabetes Upstream: the Social Determinants of Diabetes Management and Control Among Immigrants in the US

PURPOSE OF REVIEW

Relative to the US-born population, immigrants are less likely to successfully manage and control their diabetes, leading to a host of diabetes-related complications. This review draws on the social determinants of health framework (SDoH) to summarize the multilevel factors that shape diabetes care and management among immigrants in the USA.

RECENT FINDINGS

While the diabetes literature is replete with research on individual-level risk factors and health behaviors, empirical literature linking the SDoH to diabetes management among immigrants is limited. However, housing precarity, food insecurity, poverty, uninsurance and underinsurance, and limited support for immigrants in healthcare systems are consistently shown to deter diabetes management and care. Immigrants with diabetes face a multitude of structural constraints to managing their diabetes. More research that theorizes the role of SDoH in diabetes management along with empirical qualitative and quantitative studies are needed. Interventions to address diabetes also require a more upstream approach in order to mitigate the drivers of diabetes disparities among immigrants.

Health literacy experiences of multi-ethnic patients and their health-care providers in the management of type 2 diabetes in Malaysia: A qualitative study

BACKGROUND

Patients with type 2 diabetes mellitus (T2DM) require adequate health literacy to understand the disease and learn self-management skills to optimize their health. However, the prevalence of limited health literacy is high in patients with T2DM, especially in Asian countries.

OBJECTIVE

This study aimed to explore experiences related to health literacy in Asian patients with T2DM.

DESIGN

This is a qualitative study using in-depth interviews and focus group discussions. A framework analysis was used to analyse the data.

SETTING AND PARTICIPANTS

articipants (n = 24) were multi-ethnic patients with T2DM (n = 18) and their primary health-care providers (n = 6). This study was conducted in four primary health-care clinics in Malaysia.

RESULTS

Nine subthemes were identified within the four dimensions of health literacy: accessing, understanding, appraising and applying information.

DISCUSSION

Motivated patients actively sought information, while others passively received information shared by family members, friends or even strangers. Language and communication skills played important roles in helping patients understand this information. Information appraisal was lacking, with patients just proceeding to apply the information obtained. Patients' use of information was influenced by their self-efficacy, and internal and external barriers.

CONCLUSION

In conclusion, the experiences of multi-ethnic patients with T2DM regarding health literacy were varied and heavily influenced by their cultures.

Health Literacy in the Everyday Lives of Older Adults in Greece, Hungary, and the Netherlands

Health literacy (HL) encompasses someone’s knowledge and abilities to access and use health information in order to make appropriate health decisions in life. HL is particularly valuable in later life when health challenges grow. An individual’s HL is typically considered a fixed and skills-based characteristic, without taking into account how these are situated in the context of everyday life. Also, lay perspectives on health literacy are relatively scarce. Therefore, the aim of this article is to explore the context-specific perspectives of older adults and health professionals on HL in later life in Greece, Hungary, and the Netherlands. We adopted a qualitative methodology and conducted 12 focus groups: seven with 50 older adults and five with 30 health professionals to gain insight into individual perspectives on HL as situated in the health care and everyday life contexts. An informed grounded theory approach was used in analyzing the data. The results are structured in three themes: (1) interactions with health professionals, (2) perceived quality of the health care system, and (3) managing health in the context of everyday life. An overarching finding is that, for older adults, HL reflects the demands placed on them when managing their health. In the experience of older adults, these demands are placed upon them by healthcare professionals, the healthcare system, as well as their everyday lives. Our findings underscore the importance of Critical Health Literacy (CHL) as that concept foregrounds that HL is context specific. Also, CHL has been argued to be a community characteristic, which is why we call for community-based approaches to improve HL.

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

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

Cancer Screening and Prevention in Lesbian, Gay, Bisexual, and Transgendered Community and Asian Lesbian, Gay, Bisexual, and Transgendered Members

Participation in cancer screening and prevention (cessation of or reduction in modifiable health risk behaviors) are the most effective methods of reducing cancer morbidity and mortality. Some members of the lesbian, gay, bisexual, and transgendered (LGBT) communities have not participated in screening for a variety of reasons which have been explored in the literature. Common and unique behavioral risks are also reviewed. Knowledge about Asian members of the LGBT community participation in cancer screening and prevention is limited. This paper reviews the current literature on participation and barriers to cancer screening and prevention for the LGBT community and provides some insights for the Asian LGBT subcommunity. Potential interventions that have been demonstrated to be effective are presented for potential implementation within nursing practice and practice settings. Suggestions for future research are also provided to enhance the care of the LGBT community.

The trigger-information-response model: Exploring health literacy during the first six months following a kidney transplantation

The main objective of this study was to explore how kidney transplant recipients find, understand, and use health information, and make decisions about their health-also known as health literacy. Kidney transplant recipients must take an active part in their health following the transplantation, since a new organ requires new medication and focus on lifestyle to prevent side-effects and signs of organ rejection. Consequently, it is of major clinical relevance to explore how kidney transplant recipients understand and relate to health literacy. Ten kidney transplant recipients were interviewed at three weeks and again at six months post-transplantation. Design and analysis were inspired by constructivist grounded theory. The results of the study are presented through a model consisting of three phases: the trigger phase, the information phase, and the response phase. The participants were influenced by context and personal factors as they moved between three phases, as information seekers, recipients, and sharers. This study illustrates health literacy as an active process. It gives new insight into what motivates kidney recipients to find, share, and receive information, and how a hierarchy of resources is built and used.

Perceptions of and Attitudes Toward Diabetes Among Chinese Americans

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.

Health literacy and cancer care coordination in Chinese migrant patients and their carers: A cross-sectional survey

OBJECTIVES

This study aimed to describe the levels of health literacy and experience of care coordination among Chinese migrant patients with cancer and their carers in Australia, and to examine factors associated with these.

METHODS

Patients' self-reported data were collected using the Health Literacy and Cancer Care Coordination questionnaires. We conducted multivariate linear regression analyses to investigate predictors of patients' health literacy and their care experience. Canonical correlation analysis was used to examine the relationship between patients' health literacy and their care experience.

RESULTS

A total of 68 patients and eight carers participated in the survey. Patients and carers reported similar levels of health literacy, with the lowest scores being in the "Having sufficient information to manage health" and "Navigating the health system" subscales. Gender (P = 0.026, partial η²  = 0.281) and educational attainment (P = 0.015, partial η²  = 0.250) had significant and large effects on patients' health literacy, after controlling for each other. Educational attainment showed a significant and medium association with patients' experience of cancer care coordination (P = 0.041, partial η²  = 0.101). A large and positive correlation was found between patients' health literacy and experience of cancer care coordination (canonical correlation = 0.81).

CONCLUSIONS

Our findings reveal the health literacy and care coordination needs of Chinese migrant patients with cancer in Australia, especially those with lower educational attainment. Future efforts are necessary to enhance Chinese migrants' health literacy and establish an accessible and easy-to-navigate care environment.

Identification of Family Factors That Affect Self-Management Behaviors Among Patients With Type 2 Diabetes: A Qualitative Descriptive Study in Chinese Communities

INTRODUCTION

In the past 30 years, the prevalence of diabetes in China has increased from 0.67% to 11.6%. Self-management behaviors (SMBs) are significant to improve health outcomes for diabetics. However, little is known about self-management experiences of Chinese diabetic patients. The purpose of this study was to explore family factors affecting SMBs.

METHODOLOGY

A qualitative descriptive study was used. Purposive samples were recruited from Chinese communities. Semistructured interviews were conducted, and audio-recordings transcripts were analyzed using content analysis methods.

RESULTS

Twenty participants were interviewed, including 8 with well-controlled HbA1c while 12 were poorly controlled. Facilitators that promote patients' SMBs were responsibility toward children and commitment to spouse; barriers that hinder patients' SMBs were family experiences about starvation, seeking harmony-eating in a big family, living in an "empty nest," and family financial burden.

DISCUSSION

This study provides insight into SMBs of Chinese diabetic patients. Professionals can develop tailored interventions in a Chinese cultural context according to patients' perceptions of family responsibility, early experience, activities, and resources.

Cross-Validating a Structural Model of Factors Influencing Diabetes Self-Management in Chinese Americans with Type 2 Diabetes

Introduction: The purpose of this study was to cross-validate a structural model depicting the effects of individual and environmental factors on diabetes self-management in Chinese Americans with type 2 diabetes. Methodology: A cross-sectional survey was administered to a convenience sample of 209 Chinese Americans with type 2 diabetes in the Midwest of the United States. Structural equation modeling was used to cross-validate the model fit. Results: Provider–patient communication indirectly influenced self-management via belief in treatment. Knowledge indirectly influenced self-management via belief in treatment and self-efficacy. Social support indirectly influenced self-management via belief in treatment and knowledge. Discussion: This study demonstrated that the structural model, previously tested with Chinese diabetes patients in China, also fits Chinese Americans in the United States with few modifications. The cross-validated model provides a theoretical basis for developing culturally relevant diabetes self-management interventions for Chinese Americans, which may lead to health improvements in this ethnic population.

Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention: A Scientific Statement From the American Heart Association

Health literacy is the degree to which individuals are able to access and process basic health information and services and thereby participate in health-related decisions. Limited health literacy is highly prevalent in the United States and is strongly associated with patient morbidity, mortality, healthcare use, and costs. The objectives of this American Heart Association scientific statement are (1) to summarize the relevance of health literacy to cardiovascular health; (2) to present the adverse associations of health literacy with cardiovascular risk factors, conditions, and treatments; (3) to suggest strategies that address barriers imposed by limited health literacy on the management and prevention of cardiovascular disease; (4) to demonstrate the contributions of health literacy to health disparities, given its association with social determinants of health; and (5) to propose future directions for how health literacy can be integrated into the American Heart Association's mandate to advance cardiovascular treatment and research, thereby improving patient care and public health. Inadequate health literacy is a barrier to the American Heart Association meeting its 2020 Impact Goals, and this statement articulates the rationale to anticipate and address the adverse cardiovascular effects associated with health literacy.

Healthcare Communication Barriers and Self-Rated Health in Older Chinese American Immigrants

Older Chinese immigrants are a growing population in the United States who experience multiple healthcare communication barriers such as limited English proficiency and low health literacy. Each of these obstacles has been associated with poor health outcomes but less is known about their effects in combination. This study examined the association between healthcare communication barriers and self-rated health among older Chinese immigrants. Cross-sectional survey data were obtained from 705 Chinese American immigrants ages 50-75 living in San Francisco, California. Communication barriers examined included spoken English proficiency, medical interpreter needs, and health literacy in written health information. The study sample (81 % females, mean age = 62) included 67 % who spoke English poorly or not at all, 34 % who reported needing a medical interpreter, and 37 % who reported "often" or "always" needing assistance to read health information. Two-thirds reported poor self-rated health; many reported having access to racial-concordant (74 %) and language-concordant (86 %) healthcare services. Both poor spoken English proficiency and low health literacy were associated with poor self-rated health, independent of other significant correlates (unemployment, chronic health conditions, and having a primary doctor who was ethnic Chinese). Results revealed that spoken English proficiency and print health literacy are independent communication barriers that are directly associated with health status among elderly Chinese American immigrants. Access to racial- or language-concordant health care services did not appear to resolve these barriers. These findings underscore the importance of addressing both spoken and written healthcare communication needs among older Chinese American immigrants.

Health literacy and meeting breast and cervical cancer screening guidelines among Asians and whites in California

Objectives

Empirical evidence regarding cancer screening and health literacy is mixed. Cancer is the leading cause of death in Asian Americans, yet screening rates are notably low. Using a population-based sample, we determined if health literacy: (1) was associated with breast and cervical cancer screening, and (2) helped to explain Asian cancer screening disparities.

Methods

We analyzed the 2007 California Health Interview Survey for Asian (Japanese, Chinese, Filipino, Korean, Vietnamese, other Asian) and white women within age groups relevant to US Preventive Services Task Force (USPSTF) screening guidelines: cervical: ages 21–65 (n = 15,210) and breast: ages 50–74 (n = 11,163). Multilevel logistic regression models predicted meeting USPSTF screening guidelines both with and without self-reported health literacy controlling for individual-level and contextual-level factors.

Results

Low health literacy significantly (p < 0.05) predicted lower cancer screening in final models for both cancer types. In unadjusted models, Asians were significantly less likely than whites to receive both screening types and significantly more likely to report low health literacy. However, in multivariable models, the addition of the low health literacy variable did not diminish Asian vs. white cancer screening disparities.

Conclusions

Self-reported health literacy predicted cervical and breast cancer screening, but was not able to explain Asian cancer screening disparities. We provide new evidence to support a relationship between health literacy and cancer screening. Health literacy is likely a useful focus for interventions to improve cancer screening and ultimately reduce the burden of cancer. To specifically reduce Asian cancer disparities, additional areas of focus should be considered.