Adapting a measure of acculturation for cross-cultural research

Translation and validation of the East Asian Acculturation Measure (EAAM) among Myanmar migrants in Thailand

Background

Acculturation provides a framework for exploring the health behaviors of ethnic minority or cultural groups. Research on the acculturation level and patterns of Myanmar migrants is crucial since there is ample evidence that acculturation promotes health-promoting behaviors. However, no Myanmar version has undergone cross-cultural validation.

Objective

This study aimed to translate the original East Asian Acculturation Measure (EAAM) into the Myanmar version (EAAM-M) and investigate its psychometric properties.

Methods

The validation study was conducted on a sample of 200 Myanmar migrants in three factories in Bangkok, Thailand, by a multistage random sampling method from August to September 2023. Brislin's back translation technique was applied to convert the original EAAM into its modified version, EAAM-M. The reliability, content validity, and construct validity of the EAAM-M were examined, and confirmatory factor analysis (CFA) was employed to test the appropriateness of the model that underpins the EAAM-M structure.

Results

The average age of the participants was 38.39 years (SD = 5.56), and 68% of participants reported they earned less than 9000 baht. In terms of how long they stayed in Thailand, slightly over half (52.5%) did so for 1-5 years. Nearly half of them (46%) cannot communicate at all regarding their proficiency in speaking Thai. The score regarding the comparability of language and similarity of interpretability between the original EAAM and the EAAM-M was satisfactory. The overall alpha reliability of the EAAM-M was 0.76. Based on the CFA, the measurement model was well fit, with acceptable goodness-of-fit values (Chi-square test of model fit (p = 0.05), CMIN/df = 1.70 (χ2 = 624.931, df = 366), RMSEA = 0.02, CFI = 0.98, and SRMR = 0.06). The validity and reliability of the factors were affirmed through appropriate factor loadings and satisfactory levels of composite reliability (0.942) and average variance extracted (0.538).

Conclusion

The EAAM-M is a reliable and valid instrument to measure the acculturation patterns of Myanmar migrants. It is beneficial for scholars across various disciplines, including health professionals and nurses, to deliver culturally tailored care for migrants.

Ang Ating Mata: Disparities in Eye Health Knowledge, Attitudes and Practices among Older Adult Filipino-Americans in the San Francisco Bay Area Counties

Filipino-Americans are the third largest Asian-American population, with a median age of 44. However, there is limited literature focusing on the group's ophthalmic care engagement. Timely eye examinations and outreach are necessary to reduce visual impairment in this older community. To assess eye care knowledge, attitudes, and practices, we conducted a cross-sectional study surveying Filipino-Americans within the nine San Francisco Bay Area counties. Associations between primary outcomes and sociodemographic factors were analyzed using chi-squared analysis and student's T-test. In our convenience sample of 256 surveys, a majority of participants are receiving appropriate eye care; those that lacked health and eye insurance, immigrated and are lower income did not receive optimal eye care. Study participants also demonstrated a lack of awareness of eye diseases and risk factors. Our results suggest that culturally sensitive eye health education materials are lacking and should be made accessible for this large and rapidly growing population.

Involuntary Cultural Change and Mental Health Status Among Indigenous Groups: A Synthesis of Existing Literature

Indigenous groups throughout the world have experienced social exclusion and have been subjected to marginalization. Globalization has resulted in significant changes in traditional lifestyles and developmental programs have not been successful in integrating Indigenous people into communities with non-Indigenous people. Although there is substantial research on acculturation and adaptation within the field of cross-cultural psychology, there are few narrative reviews of this literature. The present paper provides such a review and examines the mental health concerns of Indigenous groups undergoing acculturation. We address the consequences of involuntary cultural change and review studies that have been conducted on mental health issues, psychosomatic symptoms, substance use, and suicidality in Indigenous groups. We conclude by offering suggestions to mitigate mental health problems. Directions for future research on the acculturation of Indigenous groups are also provided.

A tale of two cultural life scripts: do young second-generation Turkish immigrants versus young Danes in Denmark perceive life through different cultural lenses?

Cultural life scripts refer to the shared expectations as to the order and timing of life events in a prototypical life course within a given culture or subculture. Immigration is a significant transition that often implies a change in cultural context, which may change people's views about a normative life. However, research on cultural life scripts in the context of immigration has been limited. We addressed this gap by examining the cultural life scripts of 33 young second-generation Turkish immigrants and 33 young Danes in Denmark, pairwise-matched on age, gender, and education, along with their subjective well-being and acculturation level. Both groups reported mostly positive life script events expected to occur in early adulthood and their individual life scripts generally had a positive outlook. In contrast to earlier studies, we found no evidence of lower subjective well-being or greater normativity of the cultural life script in the immigrant group. Moreover, the acculturation level of the Turkish group correlated positively with their subjective well-being, suggesting that adapting at least to some degree to the daily life of the host country is associated with well-being of second-generation immigrants.

Effects of Acculturation on the Cross-Cultural Neuropsychological Test Battery (CNTB) in a Culturally and Linguistically Diverse Population in Denmark

OBJECTIVE

Assessment of individuals from diverse ethnic backgrounds is a major challenge in current clinical neuropsychology as most neuropsychological tests are biased by linguistic, educational, and cultural differences. The aim of this study was to examine the effects of acculturation on the newly developed European Cross-Cultural Neuropsychological Test Battery.

METHOD

The study was a cross-sectional study carried out in Copenhagen, Denmark. Neuropsychological test performances of a Danish sample were compared to a culturally and linguistically diverse sample, and the effects of a number of acculturation variables were assessed using group comparisons, correlation analyses, and regression analyses.

RESULTS

A total of 152 participants were included in the study: 26 were native-born monolingual Danes and 126 had culturally and linguistically diverse backgrounds: 66 were immigrants from Turkey, 41 from Poland, and 19 from former Yugoslavia. In direct comparison, the only significant difference between the Danish and culturally and linguistically diverse samples was found on Animal Fluency. However, within the culturally and linguistically diverse sample, higher and lower acculturated groups significantly differed on several measures. The main associations between neuropsychological test performance and acculturation variables were found on measures loading on processing speed and executive function.

CONCLUSIONS

Overall, only limited effects of acculturation were found on the European Cross-Cultural Neuropsychological Test Battery. However, administering cross-cultural measures in the preferred language may not be sufficient to resolve challenges in cross-cultural assessment of processing speed and executive function as concept of speed and speeded performance is highly culture dependent.

Components of Culturally Tailored Interventions: A Discussion Paper

The purpose of this article is to propose essential components of culturally tailored interventions through analyzing practical issues in 3 studies that tested culturally tailored interventions among Asian American women. Practical issues in the studies were analyzed using a content analysis according to the evaluation criteria for rigor in cross-cultural research. Seven essential components of culturally tailored interventions were identified through the analysis: (a) respecting cultural uniqueness; (b) understanding cultural contexts; (c) using cultural examples; (d) having flexibility; (e) adopting multiple languages; (f) having bilingual and/or culturally matched research team members; and (g) engaging community consultants and research participants. Key words: Asian, culture, intervention, issue, rigor.

Culturally Sensitive OCD Research: Lessons from the U.S.-Mexico Border

This paper explores culturally-related concerns that arose during a multi-year study of obsessive-compulsive disorder (OCD) along the U.S.-Mexico border and describes adaptations made to better connect the research process to study participants. The purpose of this exploration is two-fold: (1) to offer suggestions for culturally sensitive borderland mental health research; and (2) to enhance dialog focused on culture, mental health research and the U.S.-Mexico border. Systematic coding of the written record of weekly research team meetings identified six recurring cultural concerns: emotionally charged and poorly understood terminology; differing meanings of ethnicity and acculturation; quality of life-regional variation and uncertainty; overlap of research and care; hopeful but hesitant; and fatalism. We conclude that diligence in the initial planning phase of a study is only part of the challenge in doing culturally sensitive research. Equally important is an ongoing process of evaluation to make explicit cultural concerns that arise during research, as well as a readiness to implement culturally sensitive research adaptations.

The factor structure of a short acculturation scale for Filipino Americans in an adult U.S.-born sample

The influx of non-European immigrants since 1965 ushered the development and use of acculturation measures in immigrant health studies. A Short Acculturation Scale for Filipino Americans (ASASFA) represents a validated, unidirectional ethnic-specific measure used with first-generation FAs. ASASFA's psychometric properties with adult U.S.-born children-the second generation-remain unexplored. This study determined (a) the factor structure of ASASFA with adult U.S.-born FAs and (b) the predictors of their acculturation scores. A secondary analysis was conducted on ASASFA data from a mental health survey of 116 U.S.-born FAs. Exploratory factor and parallel analyses showed a two-factor solution: language use and preference (Factor 1) and ethnic social relations (Factor 2). Ordinary least squares regression indicated gender and ethnic self-identification predict Factor 1 scores; self-identification solely predicts Factor 2 scores. Results demonstrate ASASFA's validity and parsimony, supporting its use in FA health studies when lengthy bidirectional acculturation measures become impractical.

Self-care among Filipinos in the United States who have hypertension

BACKGROUND

Despite the strong literature on the influence of self-care on hypertension (HTN) diagnosis, there is a notable lack of studies that explore self-care among Filipino immigrants in the United States (US) who have HTN.

AIM

To determine the levels of and relationships between and among acculturation, acculturative stress, HTN self-efficacy, patient activation, and HTN self-care among first generation Filipino immigrants in the US who have HTN.

DESIGN

A cross-sectional correlational design was used to determine the relationships between and among acculturation, acculturative stress, HTN self-efficacy, patient activation, and HTN self-care using the Transactional Model of Stress and Coping. One hundred and sixty-three community-dwelling first-generation Filipino immigrants participated in the study.

METHODS

Data on HTN self-care, acculturation, acculturative stress, HTN self-efficacy, and patient activation were collected.

RESULTS

The study results revealed that HTN self-efficacy and patient activation significantly contributed to the regression model that accounted for 29.5% of the variance in HTN self-care for this sample. Further analysis revealed that patient activation had a mediating role between HTN self-efficacy and HTN self-care.

CONCLUSIONS

Findings from this study revealed that HTN self-efficacy and patient activation were associated with self-care behaviors associated with HTN management for this sample.

CLINICAL RELEVANCE

Findings from this study highlight the importance of addressing HTN self-efficacy and patient activation in improving HTN self-care for this population.

Translation of Domestic Violence Instruments for Use in Research

The Abuse Assessment Screen, Severity of Violence Against Women Scales, and Appraisal of Violent Situations scales were translated into versions for women originating from Brazil, Haiti, the Dominican Republic, and Puerto Rico. The procedure of back translation was chosen as the most reliable method for translation of these three instruments. The translated instruments were used to screen women for abuse during pregnancy and to determine the prevalence and severity of that abuse. This article discusses the translation process and illustrate with versions of the instruments for use with pregnant women from Puerto Rico.

Knowledge and perceptions of dementia and Alzheimer's disease in four ethnic groups in Copenhagen, Denmark

OBJECTIVE

Older people from ethnic minorities are underrepresented in dementia care. Some of the determinants of access to care are knowledge and perceptions of dementia, which may vary between ethnic groups in the population. The aims of this study were to compare knowledge and perceptions of dementia and Alzheimer's disease (AD) among four ethnic groups in Copenhagen, Denmark, and to assess the influence of education and acculturation.

METHODS

Quantitative survey data from 260 participants were analyzed: 100 native Danish, and 47 Polish, 51 Turkish, and 62 Pakistani immigrants. Knowledge and perceptions of dementia and AD were assessed with the Dementia Knowledge Questionnaire (DKQ) supplemented with two questions from the Alzheimer's Disease Awareness Test (ADAT). Knowledge and perceptions of dementia and AD in the four groups were compared, and the influence of education and acculturation was assessed.

RESULTS

Group differences were found on the DKQ total score as well as all sub-domains. Turkish and Pakistani people were most likely to hold normalizing and stigmatizing views of AD. Level of education and acculturation had limited influence on dementia knowledge, accounting for 22% of the variance at most and had only minor influence on perceptions of AD.

CONCLUSIONS

Lacking knowledge and certain perceptions of dementia and AD may hamper access to services in some ethnic minority groups. Ongoing efforts to raise awareness that dementia and AD are not part of normal aging, particularly among Turkish and Pakistani communities, should be a high priority for educational outreach.

Dietary Acculturation among Filipino Americans

Acculturation, the subsequent changes that occur in one culture after continuous first hand contact with another culture, impacts the dietary habits and health risks of individuals. This study examines the acculturation, dietary habits and anthropometric measurements in a sample of 210 first generation Filipino American immigrants in New Jersey (NJ). Acculturation was measured using the Short Acculturation Scale for Filipino Americans (ASASFA). Dietary acculturation was measured using the Dietary Acculturation Questionnaire for Filipino Americans (DAQFA) and dietary intake was determined using the Block's Brief Food Frequency Questionnaire (BFFQ). Anthropometric measurements were obtained including weight, height and waist circumference. Acculturation had a significant negative relationship with Filipino Dietary acculturation. Western dietary acculturation was significantly correlated with caloric intake (r(208) = 0.193, p < 0.01), percentage fat intake (r(208) = 0.154, p < 0.05), percentage carbohydrate intake (r(208) = -0.172, p < 0.05), Body Mass Index (BMI) (r(208) = 0.216, p < 0.01) and waist circumference (r(208) = 0.161, p < 0.01). There was no significant correlation between Filipino dietary acculturation, dietary intake and anthropometric measurements. The results showed that Filipino American immigrants have increased risks including increased BMI, waist circumference and increased fat intake. Over all, this research highlighted some dietary changes and their effects on dietary intake and health status.

Contextually appropriate measurement as the basis for culturally appropriate interventions: a case study in Managua, Nicaragua

Despite recent advances in U.S. health care, racial and ethnic minorities experience significantly worse health and mental health outcomes. Policy responses to this problem are based on available research, which is often premised on a misinterpretation of the cultural concepts that underlie people's health and mental health. Health researchers often rely upon measurements with questionable cultural validity. This contributes to a lack of understanding of health disparities that nondominant populations experience and creates obstacles to the development of effective policies to alleviate them. Even statistically valid or literally translated measurements often fail to account for different social and cultural contexts and/or neglect to consider vital information about the population studied or its history. This article reports on the content validity of measures used in a study that investigated predictors of mental health in Managua, Nicaragua. Results reveal a polarized response structure and lack of cultural relevance in underlying concepts measured.

Validation of Arabic and English versions of the ARSMA-II Acculturation Rating Scale

To translate and adapt the Acculturation Rating Scale of Mexican-Americans II (ARSMA-II) for Arab Americans. A multistage translation process followed by a pilot and a large study. The translated and adapted versions, Acculturation Rating Scale for Arabic Americans-II Arabic and English (ARSAA-IIA, ARSAA-IIE), were validated in a sample of 297 Arab Americans. Factor analyses with principal axis factoring extractions and direct oblimin rotations were used to identify the underlying structure of ARSAA-II. Factor analysis confirmed the underlying structure of ARSAA-II and produced two interpretable factors labeled as 'Attraction to American Culture' (AAmC) and 'Attraction to Arabic Culture' (AArC). The Cronbach's alphas of AAmC and AArC were .89 and .85 respectively. Findings support ARSAA-II A & E to assess acculturation among Arab Americans. The emergent factors of ARSAA-II support the theoretical structure of the original ARSMA-II tool and show high internal consistency.

Evaluation of a community health worker pilot intervention to improve diabetes management in Bangladeshi immigrants with type 2 diabetes in New York City

PURPOSE

The purpose of this study is to explore the impact and feasibility of a pilot Community Health Worker (CHW) intervention to improve diabetes management among Bangladeshi-American individuals with type 2 diabetes living in New York City.

METHODS

Participants were recruited at clinic- and community-based venues. The intervention consisted of 6 monthly, CHW-facilitated group sessions on topics related to management of diabetes. Surveys were collected at baseline and follow-up time points. Study outcomes included clinical, behavioral, and satisfaction measures for participants, as well as qualitative measures from CHWs.

RESULTS

Improvements were seen in diabetes knowledge, exercise and diet to control diabetes, frequency of checking feet, medication compliance, and self-efficacy of health and physical activity from baseline to 12 months. Additionally, there were decreases in A1C, weight, and body mass index. Program evaluation revealed a high acceptability of the intervention, and qualitative findings indicated that CHWs helped overcome barriers and facilitated program outcomes through communal concordance, trust, and leadership.

CONCLUSIONS

The intervention demonstrated high acceptability and suggested efficacy in improving diabetes management outcomes among Bangladeshi immigrants in an urban setting. The US Bangladeshi population will continue to increase, and given the high rates of diabetes, as well as linguistic and economic barriers faced by this community, effective and culturally tailored health interventions are needed to overcome barriers and provide support for diabetes management.

Level of acculturation, food intake, dietary changes, and health status of first-generation Filipino Americans in Southern California

PURPOSE

This exploratory descriptive study investigates the acculturation level, food intake, dietary changes and practices, health status perceptions, and diet-related health indicators-body mass index (BMI), waist and hip circumferences, and waist-to-hip ratio-of first-generation Filipino Americans (FAs) in Southern California.

DATA SOURCES

Healthy FA adults-20 women and 10 men-were interviewed. Acculturation level was obtained using A Short Acculturation Scale for Filipino Americans. A 24-h dietary recall elicited their food intake. Survey questions revealed dietary changes and practices, health status perceptions, and sociodemographic characteristics. Height, weight, waist and hip circumferences were measured.

CONCLUSIONS

FAs consider themselves more Filipino than American, but their acculturation level reflects transitioning into biculturalism. FAs relinquish, maintain, and adapt elements of both Philippine and U.S. cultures in food intake, dietary changes, and practices. Although FAs perceive their health status as very good to excellent, many exceed the cut-off points for BMI, waist circumference, and waist-to-hip ratio.

IMPLICATIONS FOR PRACTICE

This study underscores the importance of nurse practitioners and other healthcare givers conducting cultural dietary assessment as a basis for culturally appropriate dietary counseling. The inclusion of waist measurement to regularly monitor abdominal obesity-a predictor of cardiovascular disease and diabetes-is highly recommended.

Testing theoretical relationships: factors influencing positive health practices (PHP) in Filipino college students

OBJECTIVE

To examine variables influencing the positive health practices (PHP) of Filipino college students to gain a better understanding of health practices in this ethnic/racial group. Cross-sectional study tested theoretical relationships postulated among (a) PHP, (b) social support (SS), (c) optimism, and (d) acculturation.

PARTICIPANTS

A sample of Filipino college students (N = 226) aged 18 to 21 was obtained in June 2009.

METHODS

Participants completed 4 instruments. Statistical analyses were performed using SPSS 16.0.

RESULTS

Positive correlations were found between PHP and SS (r = .39, p = .01) and optimism and PHP (r = .36, p = .01). No correlation was found between PHP and acculturation. Optimism and SS predicted performance of PHP (R (2) = .18, F[2, 221] = 24.927, p < .001). A difference was found in acculturation levels between participants who grew up in the United States (t[223] = 4.5, p < .001) and those who did not.

CONCLUSIONS

Findings help health practitioners and educators to better understand the underlying factors that influence PHP in this population.

Migration status in relation to clinical characteristics and barriers to care among youth with diabetes in the US

Migration status and the accompanying diversity in culture, foods and family norms, may be an important consideration for practitioners providing individualized care to treat and prevent complications among youth with diabetes. Approximately 20 % of youth in the US have ≥1 foreign-born parent. However, the proportion and characteristics of youth with diabetes and ≥1 foreign-born parent have yet to be described. Study participants (n = 3,086) were from SEARCH for Diabetes in Youth, a prospective multi-center study in the US. Primary outcomes of interest included HbA1c, body mass index and barriers to care. Multivariable analyses were carried out using logistic regression and analysis of covariance. Approximately 17 % of participants with type 1 diabetes (T1D) and 22 % with type 2 diabetes (T2D) had ≥1 foreign-born parent. Youth with T1D and ≥1 foreign-born parent were less likely to have poor glycemic control [adjusted odds ratio (OR) (95 % confidence interval): 0.70 (0.53, 0.94)]. Among youth with T2D, those with ≥1 foreign-born parent had lower odds of obesity [adjusted OR (95 % CI): 0.35 (0.17, 0.70)]. This is the first study to estimate the proportion and characteristics of youth with diabetes exposed to migration in the US. Research into potential mechanisms underlying the observed protective effects is warranted.

Comparison of performance on three neuropsychological tests in healthy Turkish immigrants and Danish elderly

BACKGROUND

Appropriate neuropsychological tests for cross-cultural assessment of dementia in elderly ethnic and linguistic minorities are generally lacking in Europe. The aim of this study was to investigate the cross-cultural applicability of the Recall of Pictures Test (RPT), Clock Reading Test (CRT), and supermarket fluency (SF) in samples of Turkish immigrants and Danish elderly.

METHODS

Samples of Turkish immigrants and Danish elderly were recruited from the Greater Copenhagen area. All participants were screened for factors known to affect cognitive test performance. Those who were included in the study underwent an approximately two-hour assessment, where the RPT, CRT, and SF were applied as a part of a comprehensive battery of neuropsychological tests.

RESULTS

A total of 109 elderly participants were included in the study: 73 Turkish and 36 Danish. Significant differences were found between the Turkish and Danish samples in CRT and SF performances, but not in any of the RPT measures. Age and acculturation level were the only demographic variables with significant impact on test performances. Performance data for the three tests are presented as percentiles.

CONCLUSIONS

Although small differences were observed between the Turkish and Danish samples on the CRT and SF, we consider the three tests to be important neuropsychological tests for assessment of dementia in elderly patients from ethnic minority migrant populations.

Acculturation and health status among Hispanic American elders

PURPOSE

Hispanic Americans are at risk for health-related problems. Disparities in diseases such as diabetes and obesity, poor access to health services, and lack of health insurance have placed Hispanic Americans at a disadvantage. Sociocultural factors such as acculturation and its relationship to health require further investigation. The primary purpose of this study was to identify the relationship between acculturation and health in Hispanic American elders and examine the interrelationships of acculturation, health status, age, gender, education, years in the United States, and income.

DESIGN

This descriptive correlational study was a secondary analysis of data from a large study titled Culture Bias in Testing Expressive Ability in Dementia.

METHODS

A total sample of 132 community-dwelling Hispanic American elders was used. The Cross Cultural Measure of Acculturation was used to measure acculturation, and health status was measured using the SF-8® Health Survey. Correlation and multiple linear regressions were used to analyze the data.

DISCUSSION/CONCLUSIONS

Findings from the study revealed that participants who were more acculturated to mainstream American culture reported their mental health to be better but not their physical health. This is an important contribution to advancing knowledge about cultural and health issues among Hispanic American elders, with implications for the clinical setting and for providing more culturally competent care.

Does cultural assimilation influence prevalence and presentation of depressive symptoms in older Japanese American men? The Honolulu-Asia aging study

OBJECTIVE

: Sociocultural factors have been implicated in affecting prevalence, incidence, and diagnosis of depression but previous studies have included heterogeneous ethnic populations. We studied the influence of cultural assimilation on the prevalence and presentation of depressive symptoms in elderly Japanese American men.

METHOD

: This analysis was based on 3,139 Japanese American men aged 71-93 years who were participants in the Honolulu-Asia Aging Study between 1991 and 1993. We created a Cultural Assimilation Scale (CAS) using 8 questions assessing the degree of Japanese identity and lifestyle compared to a Western one. Subjects were divided into tertiles of CAS score for analysis. Prevalence of depressive symptoms was measured using an 11-question version of the Centers for Epidemiologic Studies Depression Scale questionnaire, and presence of depressive symptoms was defined as score 9 or more.

RESULTS

: Prevalent depressive symptoms did not reach a statistically significant association with CAS tertiles (Western, 10.8%; Mixed, 9.6%; and Japanese, 8.5%). However after adjusting for demographic, functional, and disease factors, the most culturally Japanese group had significantly lower odds for prevalent depressive symptoms, compared to the most Western group. Among the subset of subjects with a high-Centers for Epidemiologic Studies Depression Scale-11 score, there were no significant differences in both mean psychological scores and mean somatic scores between the three CAS groups.

CONCLUSIONS

: Prevalent depressive symptoms were significantly lower among elderly Japanese American men who were most culturally Japanese, compared to more westernized men. Improving knowledge and understanding about the pathogenesis of depression will have important public health implications.

Effects of length of stay and language proficiency on health care experiences among immigrants in Canada and the United States

This study sought to examine the influence of length of stay and language proficiency on immigrants' access to and utilization of care in Canada and the United States (U.S,). Data came from the 2007-2008 Canadian Community Health Survey and the National Health Interview Survey. Analyses were limited to foreign-born, non-elderly adults in each country (n = 12,870 in Canada and n = 7440 in the U.S.). Health care indicators included having a usual source of care; annual consultation with a health professional, dentist, and eye doctor; flu shot in the past year; and Pap test in the past 3 years. Logistic regression models were employed to estimate the relative odds of access or use of care, adjusting for need, demographic factors, socioeconomic status, and insurance coverage. In general, rates of health care access and utilization were higher in Canada than the U.S. among all immigrant groups. In both countries, adjusted analyses indicated that immigrants with shorter length of stay (less than 10 years) and limited language proficiency generally had lower rates of access/use compared with those with longer length of stay (10 years or more) and proficiency in each country's official language(s), respectively. There was one exception to this pattern in the U.S.: immigrants with limited English had higher odds of having a recent Pap test relative to English-proficient immigrants. The persistence of disparities in health care experiences based on length of stay and language proficiency in Canada suggests that universal health insurance coverage may not be sufficient for ensuring access to and utilization of primary and preventive care for this population.

Concept analysis of acculturation in Filipino immigrants within health context

Although acculturation has been widely used as a health research variable among other immigrant populations, it is nonexistent to the Filipino immigrant population. Accurate assessment, measurement, and exploration of acculturation of Filipinos in the United States can help improve the overall health care of this population. The work of Walker and Avant is used as a guide to analyze and clarify the operational definition of acculturation of this group within the context of health.

Assessment of dietary intakes of Filipino-Americans: implications for food frequency questionnaire design

OBJECTIVE

The purpose of this study was to describe food consumption practices of Filipino-American adults, to describe how they respond to a food frequency questionnaire (FFQ) as a function of acculturation and sex, and to suggest modifications to the FFQ to improve dietary assessment among Filipino-Americans.

METHODS

Twenty-one Filipino-American women and 14 Filipino-American men (aged 30-60 years) who varied on acculturation level were recruited from the general community of San Diego, California. Participants completed a focus group and rated the Fred Hutchinson Food Frequency Questionnaire.

RESULTS

The most commonly eaten food items among Filipino-Americans were white rice, fish or meat, vegetables, and fruit. Most (76%) participants reported that the Fred Hutchinson Food Frequency Questionnaire lacked commonly eaten Filipino-American food.

CONCLUSIONS AND IMPLICATIONS

Commonly consumed food, such as adobo, lumpia, and pansit, might be added to a revised FFQ; doing so may improve recall and face validity among Filipino-Americans.

Food system access, shopping behavior, and influences on purchasing groceries in adult Hmong living in Minnesota

PURPOSE

To investigate influences on shopping and eating behavior of Hmong adults living in St. Paul/Minneapolis, Minnesota.

DESIGN AND SETTING

Conducted a mapping project, food surveys, food frequency questionnaire (FFQ), and focus groups (n = 11).

SUBJECTS

Subjects were assigned to three groups. The B-TL(1) group was made up of subjects who were born in Thailand/Laos and had lived in the US < or =5 years (n = 19). The B-TL(2) group was made up of subjects who were born in Thailand/Laos, had food memories, and had lived in the US >5 years (n = 20). The B-US group was made up of subjects who were born and/or raised in the US (n = 30).

METHODS

Using Geographical Informational Systems software, 15 grocery stores were mapped and surveyed. Food prices were compared with the consumer price index (CPI). The FFQ assessed food consumption patterns. Focus group transcripts were evaluated for themes and coded. Degree of acculturation was assessed by adapting a previously developed instrument.

RESULTS

The population is concentrated in St. Paul, coinciding with store density. Limited foods had CPIs and some CPIs were outdated. B-US had significantly higher levels of dietary acculturation than B-TL(2) and B-TL(1), with B-TL(2) also having a higher dietary acculturation level compared with B-TL(1). Acculturation of the Hmong into the American food system, determinants of store type, and Hmong food's having a mainstream factor were identified themes.

CONCLUSIONS

B-US and B-TL(2) shopped at American stores more than did B-TL(1) because of convenience, one-stop shopping, and increased English fluency. Hmong foods have entered the American food system and are sold at Asian and American stores.

Risk perception and beliefs regarding HIV infection among Ethiopian immigrants

In Ethiopia, approximately 7.5% of the urban population is HIV-positive, and countrywide 1.5 million people are living with HIV. Between 1990 and 2000, immigration into the United States by African-born immigrants increased by 130%. Of this immigrant population, individuals from Ethiopia make up a significant portion. Although there is a rich literature addressing the beliefs regarding HIV and risk perception among some immigrant populations in the United States, few studies target Ethiopian-born residents. Thus, a survey-based study addressing demographics, acculturation, awareness, beliefs and risk perception, attitudes toward susceptibility for infection, and risk behaviors targeted Ethiopian-born residents of San Diego, California. Results indicate a separation between understanding of HIV transmission and personal risk perception for infection in a young, highly educated, predominantly male participant pool. As an initial study of HIV beliefs and risk perception in the immigrant Ethiopian population, our results provide information on specific areas warranting further investigation.

Filipino nurses in the United States: recruitment, retention, occupational stress, and job satisfaction

Solutions to the nursing shortage in North America include the recruitment of international nurses. This descriptive study examines strategies to facilitate the cultural adaptation, job satisfaction, and perception of role and social support of a group of recruited Filipino nurses. Instruments used were the Nursing Work Index-Revised Edition and Occupation Stress Inventory-Revised Edition. Results indicated that the investment in promoting the well-being of recruits in both social and work contexts positively benefits job satisfaction and spills over into related areas of satisfaction and positive adaptation. The literature study also focuses on areas of cultural competence in the context of transcultural nursing.

Job-related stress and chronic health conditions among Filipino immigrants

OBJECTIVES

We investigate how duration in the US impacts the relationship between job-related stress and health conditions among Filipino immigrants.

METHODS

Using data from the Filipino American Community Epidemiologic Study, a cross-sectional sample of 1,381 immigrant Filipinos was obtained. Negative binomial regression was used to examine the interaction between years residing in the US and job concerns on number of self-reported health conditions.

RESULTS

Job concern is positively associated with health conditions for all immigrants no matter what length of time they have spent in the US. This association is strongest for recent immigrants and the strength of the association weakened with increasing time spent in the US.

CONCLUSIONS

Findings suggest that job-related stressors are associated with adverse health outcomes among Filipino immigrants and that this relationship is strongest for newer immigrants. New immigrants should be recognized as a vulnerable group with regard to the impact of work on their well-being.

Understanding the cultural health belief model influencing health behaviors and health-related quality of life between Latina and Asian-American breast cancer survivors

PURPOSE

The purpose of this study was to (1) describe health behaviors and health-related quality of life (HRQOL) of Latina and Asian-American breast cancer survivors (BCS), (2) estimate possible culturally driven predictors of health behaviors and HRQOL, and (3) compare pathways for predicting health behaviors and HRQOL between the two groups.

MATERIALS AND METHODS

Secondary data were used to investigate health behaviors and HRQOL among 183 Latina and 206 Asian Americans diagnosed with breast cancer. The study methodology was guided by the health belief model and the contextual model of HRQOL. Structural equation modeling was used to test cultural predictors on health behaviors of BCS.

RESULTS

Asian Americans reported higher emotional and physical well-being scores than Latina-Americans. Confirmatory factor analyses demonstrated the adequacy of the two-factor model ("powerful others" and "sociocultural factors") in the cultural health belief construct for Latina and Asian-American BCS. In the structural model, Latinas and Asian Americans showed different pathways in the predicted relationships among the variables. For Latina-Americans, doctor-patient relationship was positively related to exercise, and in turn, influenced physical and emotional well-being. For Asian Americans, treatment decisions and the "sociocultural factor" were significantly related to stress management.

CONCLUSION

This study adds to the existing literature in that no study has focused on cultural health beliefs and health behaviors between Latina and Asian-American BCS. Evidence that Latinas and Asian Americans varied in the patterns of cultural factors influencing health behaviors and HRQOL might lead to the development of culturally sensitive breast cancer interventions for promoting positive health behavior and ultimately increasing HRQOL.

Acculturation and environmental change impacts dietary habits among adult Hmong

Focus groups (n=65) were conducted with Hmong adults in St. Paul/Minneapolis, MN to determine how environmental factors, acculturation, and food insecurity influence dietary behavior, body mass index (BMI), and health. Acculturation was assessed by examining linguistic, social, and eating behavior, length of time in the US, and BMI for B-TL(1) (born in Thailand/Laos and in US < or =5 years), B-TL(2) (in Thailand/Laos through adolescence, had food memories, and in US >5 years), and B-US (born in US or in Thailand/Laos less than 8 years and no food memories from there). Acculturation was associated with years lived in the US, household size and income, and food assistance usage. Years lived in the US was correlated with food assistance usage, education, household size and income, and perception of diet. B-TL(1) and B-TL(2) were on average overweight (BMI> or =25<30), US men were obese (mean BMI=32.4+/-7.4), and women were overweight (mean BMI=29.1+/-6.8). Themes identified were cultural values impact eating and lifestyle behaviors, food insecurity history influences post-migration behavior, acculturation impacts BMI through diet and exercise, and health status is influenced by changed environments. Environmental changes and increased acculturation have negatively impacted the weight and health of Hmong adults.

The illness beliefs, perceptions, and practices of Filipino Americans with hypertension

PURPOSE

The purpose of this study was to describe the illness beliefs, perceptions, and practices of Filipino Americans (FAs) with hypertension (HTN) to reveal their explanatory models (EMs) of the illness.

DATA SOURCES

Audiotapes and transcripts of focus group interviews and observational notes were subjected to content analysis. Medical records and related empirical studies provided supporting data.

CONCLUSIONS

In general, the EMs of FAs with HTN correspond to the biomedical model in relation to causes, consequences, and treatment of HTN. However, in spite of this biomedical knowledge, FAs with HTN have difficulty maintaining the required lifestyle changes and adhering to the medication regimen to control their illness.

IMPLICATIONS FOR PRACTICE

It is important for NPs to assess the EMs of FAs with HTN, including their use of traditional folk remedies and practitioners of folk medicine. The challenge is to provide cardiovascular health promotion and education in a culturally sensitive, congruent, and tailored manner to FAs with HTN to help them control their illness.

The effect of parental immigration authorization on health insurance coverage for migrant Latino children

OBJECTIVE

To examine if immigration authorization among parents is associated with health insurance coverage for migrant Latino children.

DATA SOURCE

A cross-sectional household survey of 300 migrant families for which one child, aged <13 years, was randomly selected.

RESULTS

Most children lacked insurance (73%) and had unauthorized parents (77%). Having an authorized parent or parental stay of more than 5 years in the US were each positively associated with children's health insurance coverage [OR: 4.9; 95% CI: (2.7-8.7) and [OR = 6.7; 95% CI: (3.8-12.0), respectively]. The effect of parental authorization did not persist in multivariable logistic regression analysis; however, more than 5 years of parental stay in the US remained associated with children's insurance coverage [OR = 4.8; 95% CI (1.8-12.2)], regardless of parental authorization.

CONCLUSION

Increased parental familiarity with US health and/or social services agencies, rather than parental authorization status, is important to obtaining health insurance for migrant children. Efforts to insure eligible migrant children should focus on recently arrived families.

Challenges and Approaches to Newcomer Health Research

Newcomers include immigrants, refugees, or asylum seekers. Approaches to research in newcomer populations include consideration of the insider–outsider status of the researcher(s), sample selection and recruitment strategies, and attention to language barriers. Potential research participants need to be identified, approached, and made to feel safe before, during, and after participation in research. Interpersonal relationships need to be negotiated with awareness of potential power imbalances, institutional discrimination, and trauma associated with premigration, migration, and settlement experiences. Embedded within these approaches should be awareness of the need to ensure the cultural safety of research participants through implementation of culturally competent research strategies.

Hispanic acculturation: a concept analysis

Although acculturation has been widely used as a health research variable among Hispanics, several inconsistencies exist in the definitions of this concept. The work of Walker and Avant is used as a guide to analyze and to clarify the definitions of acculturation in the Hispanic population. Multidisciplinary research studies involving Hispanic populations and the concept of acculturation are reviewed. Defining attributes include interaction between two cultures, change, learning, adaptation, and sociocultural context. Antecedents, consequences, case studies, and empirical referents are discussed. Implications for future practice and research are also identified.

Acculturation and parent-adolescent communication about sex in Filipino-American families: a community-based participatory research study

PURPOSE

To examine whether acculturation is associated with parent-adolescent communication about sex in Filipino-American families. Filipino-Americans, the United States' second-largest Asian and Pacific Islander (API) group, have more adolescent pregnancy and HIV infection than other APIs. High-quality parent-adolescent communication about sex has been associated with healthy sexual development, and acculturation has been associated with various increased health risks. Whether acculturation affects parent-adolescent communication is unknown.

METHODS

We surveyed 120 pairs of Filipino-American parents and adolescents at a single large high school. We asked adolescents about their frequency of parent-adolescent communication about sex and measured adolescent acculturation in two ways: disagreement with traditional Asian values and preferential use of English. In bivariate and multivariate regressions, we examined whether adolescent acculturation was associated with adolescent reports of parent-adolescent communication.

RESULTS

Few adolescents (22%) reported regularly discussing sex with parents. Although most adolescents (72%) agreed with traditional Asian values, most (63%) preferred using English. In bivariate regressions, less parent-adolescent communication about sex was associated with less adolescent agreement with traditional Asian values (p = .002) and more adolescent English use (p = .009). In multivariate regressions, these associations were largely explained by adolescent perceptions of parent knowledge about their whereabouts and activities.

CONCLUSIONS

Acculturation may influence Filipino-American parent-adolescent communication about sex and, consequently, Filipino-American adolescent sexual health. Health care and public health providers may need to tailor adolescent sexual health programs based on acculturation or other immigration-related factors.

Breast cancer among Asian Americans: is acculturation related to health-related quality of life?

PURPOSE/OBJECTIVES

To examine the association of acculturation with health-related quality of life (HRQOL) among Asian American breast cancer survivors.

DESIGN

Cross-sectional.

SETTING

Analysis of an Asian American subsample of breast cancer survivors from a larger multiethnic study.

SAMPLE

206 Asian Americans, including Chinese, Filipinos, Koreans, and Japanese. Most were diagnosed with early-stage breast cancer (stage 0-II) and were an average of 54 years old.

METHODS

Participants completed a mailed questionnaire or answered a telephone survey in English, Mandarin, or Korean. HRQOL was measured using the Functional Assessment of Cancer Therapy Breast Version 4. Acculturation was measured using an eight-item scale adapted from Marin's Short Acculturation Scale.

MAIN RESEARCH VARIABLES

HRQOL, acculturation, health insurance, life stress, and social support.

FINDINGS

Acculturation was significantly associated with HRQOL when demographic, medical, socioecologic, and healthcare access factors were controlled. However, the significant association between acculturation and HRQOL disappeared when Asian subgroup membership was considered. Subgroup differences in HRQOL remained after controlling for covariates, with Korean Americans reporting lower HRQOL than the other Asian American subgroups.

CONCLUSIONS

The absence of a significant association between acculturation and HRQOL in the final model is likely a result of the strong association between acculturation and Asian American subgroup membership. The results suggest that the correlation between acculturation and HRQOL is not an effect of having health insurance, life stress, and social support.

IMPLICATIONS FOR NURSING

Closer attention is needed regarding acculturation level; Asian American subgroup differences, including language capacity; and socioecologic characteristics in nursing practice and research.

Measures of psychological acculturation: a review

This article reviews conceptual and methodological issues in the measurement of psychological acculturation. The major issues involve the question of dimensionality and the assessment of specific domains of cultural change. Bidimensional scales that cover both overt and internal domains are more informative for the assessment of general levels of psychological acculturation. The validity of such scales must be examined in terms of the actual exposure of individuals to and involvement in each culture, and the influence of sociocultural factors on the course of acculturation. The parallel application of qualitative and quantitative methods may be useful for validity studies. The complementary use of emic and etic approaches will enhance the psychometric soundness of acculturation scales.