Barriers to the use of health services by Chinese Americans

This study examined the extent to which cultural, socioeconomic, and systemic factors impeded access to and utilization of health services among a convenience sample of 52 Chinese immigrants living in metropolitan Houston. The subjects, of differing levels of socioeconomic status, were 25 years old or older. Methods used for data collection included participant observation, face-to-face interview, and case study. A semistructured interview instrument with open- and closed-ended questions was administered. A pilot study and expert reviews were conducted for content and face validity. Cultural and socioeconomic factors were found to be strongly associated with access to and utilization of health services. Mainland Chinese and Taiwanese shared similar cultural dilemmas as they sought health care, including communication difficulties, beliefs about health, health care, and illness, and mistrust in Western health care. Although families played important roles in health decisions and choices of services, social class differences also appeared to affect utilization. For example, more affluent Taiwanese than Mainland Chinese were apt to carry health insurance and use Western systems. The findings suggest a need to improve services to the Chinese community through family-centered and community-based approaches adapted to Chinese culture.     

Use of Traditional Chinese Medicine by older Chinese immigrants in Canada

BACKGROUND: Research is needed about the usage of complementary and alternative medicines within culturally diverse groups because of a growing number of people who use these remedies. OBJECTIVE: To understand the prevalence and predictors of Traditional Chinese Medicine (TCM) use by older Chinese immigrants in Canada. METHODS: This is based on the data collected from a representative sample of 2167 elderly Chinese immigrants aged 55 years and above in seven Canadian cities. Logistic regression was used to estimate the probability of using TCM in combination with Western health services (WHS). Use of Chinese herbs, herbal formulas, and TCM practitioners (herbalists) was predicted, based upon the effects of predisposing, enabling and need factors. RESULTS: The response rate was 77%. Over two-thirds of the older Chinese immigrants reported using TCM in combination with WHS. About half (50.3%) of the older Chinese immigrants used Chinese herbs, 48.7% used Chinese herbal formulas, and 23.8% consulted a Chinese herbalist. Although separate analysis was conducted, similar predictors were identified. Country of origin, Chinese health beliefs, social support, city of residency, and health variables were the common predictors of using a form of TCM. CONCLUSION: The combined use of TCM and WHS is common among elderly Chinese immigrants. Culture-related variables are important in determining use of TCM. The predictors identified should help physicians to recognize who among the elderly Chinese immigrants are more likely to use TCM so that a more in-depth understanding toward their health practices and needs can be achieved.     

Beliefs about and responses to childhood ear infections: a study of parents in eastern North Carolina

Middle ear infection, also known as otitis media (OM), is a major public health problem among American children. Although clinical and epidemiological aspects of OM have been intensely studied, cultural factors that may be contributing to the problem of OM have received less attention. This article presents findings from an ethnographic study exploring beliefs about OM and responses to the illness among parents from eastern North Carolina. In-depth interviews were conducted with a convenience sample of nine mothers in order to learn more about parents' explanatory models of OM, the source of their beliefs, and how they respond to the illness. A survey instrument based on their statements was then constructed and administered to a convenience sample of 79 parents. The survey consisted of belief statements about OM, as well as questions pertaining to sources of beliefs, the home management of the disease, and the effects of the illness on families. A cultural consensus analysis of responses to belief statements indicates that parents shared a common model of OM. Beliefs about risks, symptoms, and causes of OM were similar to the current biomedical model of the illness, but their divergent beliefs about the diagnosis, prognosis and treatment of OM could lead to unnecessary use of health care services. Clinicians, family, and friends were reported to be important sources of information about OM. Parents also reported using similar home management strategies and care seeking behaviors to minimize the impact of the illness on their children and families. While these findings need to be replicated in studies with larger, more representative samples, this study suggest that ethnographic approaches may provide new insights into the cultural dimension of the problem of OM.     

Dietary Characteristics and Influencing Factors on Chinese Immigrants in Canada and the United States: A Scoping Review

Background: Chinese immigrants are an integral part of Canadian and American society. Chinese immigrants believe diet to be an important aspect of health, and dietary behaviours in this population have been associated with changes in disease risk factors and disease incidence. This review aims to summarize the characteristics of the dietary behaviours of Chinese immigrants and the associated influencing factors to better inform individual, clinical, and policy decisions. Methods: This scoping review was written in accordance with PRISMA guidelines. MEDLINE, PsychINFO, CINAHL, AgeLine, ERIC, ProQuest, Nursing and Allied Health Database, PsychARTICLES, and Sociology Database were utilized for the literature search. Articles were included if they explored dietary or nutritional intake or its influencing factors for Chinese immigrants to Canada or the United States. Results: A total of 51 papers were included in this review. Among Chinese immigrants in Canada and the United States, the intake of fruits and vegetables, milk and alternatives, and fiber were inadequate against national recommendations. Chinese immigrants showed increased total consumption of food across all food groups and adoption of Western food items. Total caloric intake, meat and alternatives intake, and carbohydrate intake increased with acculturation. Individual factors (demographics, individual preferences, and nutritional awareness), familial factors (familial preferences and values, having young children in the family, and household food environment), and community factors (accessibility and cultural conceptualizations of health and eating) influenced dietary behaviours of Chinese immigrants. Discussion and Conclusion: Efforts should be undertaken to increase fruit, vegetable, and fibre consumption in this population. As dietary acculturation is inevitable, efforts must also be undertaken to ensure that healthy Western foods are adopted. It is important for healthcare providers to remain culturally sensitive when providing dietary recommendations. This can be achieved through encouragement of healthy ethnocultural foods and acknowledgement and incorporation of traditional health beliefs and values into Western evidence-based principles where possible.     

Psychosocial predictors of diet and acculturation in Chinese American and Chinese Canadian women

Objective: To examine the influence of diet-related psychosocial constructs on the dietary practices of Chinese populations living in North America. Design: Data are from a cross-sectional survey of 244 women of Chinese ethnicity living in Seattle, WA, USA and Vancouver, BC, Canada. Using an interviewer-administered questionnaire and PRECEDE/PROCEED as our model, we collected information on diet-related psychosocial (predisposing, enabling, and reinforcing) factors; consumption of foods reflecting Western and Chinese dietary practices; and past and current consumption of fruits, vegetables and fat. Results: Participants generally believed that there were strong relationships between diet and health, but only about a quarter were aware of nutrition information from the government. Food cost, availability, and convenience did not appear to be major concerns among these participants. Respondents' older relatives and spouses tended to prefer a Chinese diet and also had a strong influence on the household diet. Associations of the psychosocial factors with demographic characteristics, adoption of Western dietary practices, and consumption of fruits and vegetables were informative. For example, older, less educated respondents considered it very important to eat a low fat, high fruit and vegetable diet; while younger, more educated participants who were employed outside the home did not think the Chinese diet is healthier than a typical Western diet (all p < 0.05). Western acculturated respondents were more likely to believe in a relationship between diet and cancer/heart disease and report that preparing Chinese meals is inconvenient ( p < 0.05). Respondents with in-family normative pressure to maintain Chinese eating patterns ate more fruits and vegetables (4.4 vs 3.7 servings), while knowledge of nutrition information from the government was associated with increased fruit and vegetable consumption after immigration (all p < 0.05). Conclusions: Chinese cultural beliefs play an important role in the dietary practices of Chinese living in North America. Therefore, traditional health beliefs, as well as socioeconomic and environmental factors related to diet should be incorporated into the design and implementation of culturally appropriate health promotion programs for Chinese immigrants.     

The role of physicians' knowledge and attitudes in effective diabetes management

We examined the role of physicians' knowledge and attitudes in effective diabetes management among internal medicine house staff. We examined the extent to which (1) knowledge of common diabetes management strategies and (2) beliefs about the efficacy of, and intentions to engage in, such strategies predict success in their management of patients with diabetes. Successful managers are those house staff whose ambulatory diabetes patients' fasting blood sugar levels were lower than the clinic median. Knowledge was assessed with a written case simulation of an obese noninsulin-dependent woman; beliefs and intentions were surveyed through a self-administered questionnaire. The data suggest that knowledge was unable to discriminate physicians who are relatively successful in controlling their patient's blood sugar levels from those who are less successful. However using intentions related to initial and follow-up management strategies and beliefs about the benefits of achieving euglycemia, there was discrimination between the two physician groups (P < 0.001). These findings suggest that beliefs are important in understanding why some physicians are successful managers. Further, if beliefs are mutable, continuing medical education courses could be more effective by fostering critical beliefs rather than depending solely upon the transfer of new medical information.     

Perceptions of illness causation among new referrals to a community mental health team: "explanatory model" or "exploratory map"?

The health beliefs of people suffering from mental health problems are important. Such beliefs have been identified as key factors in models of health and illness behaviour, and may therefore indirectly influence clinical outcome. In addition, the increasing move towards patient-centred health care suggests that such beliefs need to be identified if a patient's perspective of his or her illness is to be addressed in the care process. Past research on health beliefs surrounding depression have concentrated on identifying "explanatory models" among the general community or among people who already have an established diagnosis of depression. This paper describes the content and status of health beliefs among people who are in the process of receiving a diagnosis. In-depth interviews were carried out with new referrals to a community mental health team (CMHT). Individuals expressed a variety of perceived causes throughout the interview. Beliefs were therefore characterised as changeable. It is argued that the concept of an "explanatory model" is too fixed to fully convey the fluid status of beliefs among this patient group. The concept of an "exploratory map" is suggested as a replacement. Such maps outline the avenues of thought which individuals explored when attempting to understand why they were currently experiencing particular psychological problems. The strength and persistence of beliefs is discussed in relation to both theoretical and clinical implications.     

The illness perceptions of women following acute myocardial infarction: implications for behaviour change and attendance at cardiac rehabilitation

Coronary heart disease (CHD) has been socially constructed as a gender-specific disease, with women seen not to be at risk (Lockyer, 2002). This is despite CHD being the leading cause of mortality in both men and women in the Western world (DH, 2004). The aim of this research was to explore the illness perceptions of a sample of women following acute myocardial infarction (MI). Relationships between illness perceptions and adoption of health-promoting behaviours, and attendance at a programme of cardiac rehabilitation were explored. The influence of age was also considered. Leventhal and Nerenz' Self- Regulatory Model of Illness Behaviour (1985) was used as the theoretical framework. This model consists of three stages: interpretation of symptoms, coping and appraisal. A qualitative research design was used. A purposeful sample of 10 women was selected on the basis of age and decision to attend cardiac rehabilitation. Data were collected by semi-structured interview, 3 months following the acute infarct, and analysed thematically. Stress was considered to be the cause of the MI, and although lifestyle factors were recognized, their significance was uncertain; perhaps as a result, lifestyle changes were limited. Overall, women had a perceived lack of control over the illness. The decision to attend a cardiac rehabilitation programme was influenced by beliefs relating to the identification of a known cause and level of perceived control of the illness. A belief that the illness was inevitable seemed to be more prevalent in older aged women. These findings have implications for health service providers in that they suggest that illness perceptions need to be explored and addressed before the decision to attend a programme of cardiac rehabilitation is made and health-promoting behaviours adopted.     

A review of 'traditional' aboriginal health beliefs

ABSTRACT: Western health professionals often experience difficulties in service delivery to Aboriginal people because of the disparity between Aboriginal and Western health belief systems. This article reviews the literature which considers 'traditional' Aboriginal health beliefs and medical systems. The traditional Aboriginal model of illness causation emphasises social and spiritual dysfunction as a cause of illness. Supernatural intervention is regarded as the main cause of serious illness. There are gender divisions in Aboriginal society that impact on the delivery of Western healthcare. Management strategies such as preventative care, bush medicine, and the role of traditional healers are discussed. These belief systems are considered with particular reference to their interactions and implications with regard to the Western medical system. This information provides a framework to allow improved understanding by health professionals of the health-related decisions made by Aboriginal people.     

Cultural perspectives on diabetes in an Appalachian population

OBJECTIVE: To gain an understanding of cultural and socioeconomic forces that shape beliefs about diabetes and its self-management. METHODS: Thirteen focus groups were conducted in community settings in West Virginia using a semistructured interview guide. RESULTS: Diabetes is perceived as a relatively new disease. Self-management behaviors reflect a mixture of cultural beliefs and limited resources. Moral overtones stigmatize diabetes. CONCLUSIONS: Understanding patients' illness experiences from within their cultural framework is important for successful community programming regarding chronic disease management.     

Video intervention/prevention assessment: a patient-centered methodology for understanding the adolescent illness experience.

OBJECTIVE: To better understand the issues and needs of adolescents with chronic health conditions, the Video Intervention/Prevention Assessment (VIA) integrates video technology with qualitative research methods to obtain a patient-centered perspective on illness and health care. METHODS: Young people with chronic disease are interviewed for condition-specific verbal reports (CSVRs) of their medical and psychosocial histories. Standardized health-related quality of life (HRQL) instruments are administered. Trained to use video camcorders, participants record visual narratives of their illness experiences. They document their daily lives, interview families and friends, and record personal monologues regarding their observations, behaviors, understandings, and beliefs about their disease. On completion of the visual narratives, HRQL is again evaluated. Verbal, scaled, and visual data are analyzed from three perspectives: medical, psychosocial, and anthropological. Data from the CSVRs, HRQLs, and visual narratives are triangulated to validate and enrich findings. RESULTS: Investigating the illness experience from the adolescent patient's perspective, the VIA method was pilot-tested with children and adolescents with asthma. As a research tool, VIA found environmental risk factors, medication adherence problems, and outcome-affecting illness beliefs and psychological states that were not identified by standard clinical tools. As an intervention, VIA showed that it may be an effective tool for health-related environmental surveys. Participants' condition-specific quality of life showed measurable improvement after the self-examination process of VIA. As communication, VIA made apparently counterproductive patient behaviors understandable by showing them in context with the adolescent's experience of illness and health care. VIA can enhance medical history-taking and management strategies, improve adolescents' self-management skills, and educate clinicians, families, and students of the health care professions about the realities of the adolescent living with a chronic health condition.     

Prevalence and determinants of the use of traditional Chinese medicine in Hong Kong

We studied 2,822 subjects above 18 years of age in Hong Kong by random telephone interview to assess the role of traditional Chinese medicine in health care. During their most recent illness, 73% consulted Western doctors, 17% self-medicated while 9% consulted herbalists. Age and education were important determinants of their health care choice. The most common reason given for their choice was faith in the practitioners they consulted. When they needed further consultation for the same illness, 42% consulted herbalists, illustrating that herbalists played an important supplementary role when Western medicine failed to provide relief. Compared with previous findings, there appeared to be little decline in the popularity of traditional Chinese medicine in Hong Kong.     

Between Two Worlds: The Use of Traditional and Western Health Services by Chinese Immigrants

This study examined the use of traditional and Western health services by Chinese immigrants, as well as the cultural and socioeconomic factors affecting health-seeking behaviors and health service utilization patterns among the study population from the perspectives of consumers and Chinese health care providers. Two instruments were used for data collection. The first, a consumer instrument, was designed for interviews of service recipients; the second, a health provider instrument, was designed to elicit information from traditional and Western providers. A few topics in the former instrument were cross-examined from the perspectives of health care providers. The investigation employed a combination of qualitative and quantitative research methods for data collection. Qualitative ethnographic methods used included: (1) participant-observation, (2) face-to-face interview, and (3) case study. To complement the qualitative data, structured quantitative survey were conducted with all selected informants. A total of 105 informants participated in the study: 75 Chinese consumers and 30 Chinese health professionals. The latter group was composed of Western physicians and traditional practitioners. Results revealed several patterns of health-seeking and service utilization behaviors among the Chinese of Houston and Los Angeles. These included high rates of self-treatment and home remedies (balanced diets and other alternative medicines); medium rates of utilization of integrated Western and traditional health services, including travel to country of origin for care; and low rates of exclusive utilization of Western or traditional Chinese treatments.     

The treatment strategies of arthritis sufferers

This paper describes and analyses the reasons for variation in the treatment strategies used by arthritis sufferers. The research was undertaken among 103 people from the Australian city of Perth. Qualitative data was obtained from a clinical sample of 27 and, on the basis of that, an interview schedule was constructed and administered to a survey sample of 76 self-reported arthritis sufferers. Data collected included comprehensive case histories, knowledge and beliefs about arthritis, types of practitioners consulted and treatments used and a range of demographic and socioeconomic variables. On the basis of analysis, four basic treatment strategies were discerned. Named after their most salient characteristics and ranging from least to most inclusive these were 'general practitioner and/or self care', 'medical and paramedical care', 'medical and alternative care' and use of 'all sources of care'. The most important determinants of treatment strategy were characteristics of disease--severity, mode of onset and period since onset. The longer the period since onset, the wider the range of treatments utilized. When onset occurred at a relatively young age and when progression was rapid, the more frequently alternative services and treatments were employed. Disease characteristics were followed in importance by socioeconomic factors. Use of the less inclusive strategies was related to social class; with working class people relying primarily on 'general practitioner and/or self care' and middle class people using 'medical and paramedical care'. However, when onset and progression were rapid, the disease was severe and the person relatively young socioeconomic factors were of lesser importance and people from all classes made use of the more inclusive strategies.(ABSTRACT TRUNCATED AT 250 WORDS)     

The Use of Traditional and Western Medicine Among Korean American Elderly

With the current wave of Asian immigration to the United States, awareness of their use of traditional medicine, often in combination with Western medicine, is an increasingly salient issue for health care professionals. This paper describes the use of traditional and Western medicine by Korean American elderly and factors that are associated with their health-seeking behaviors and health service utilization. Data were obtained from a convenience sample of 205 Korean elderly immigrants through interview. The findings revealed that health service utilization among Korean American elderly covered a broad spectrum of health resources, including the use of Western medicine, the traditional Korean medicine (hanbang), or both Western and traditional clinics. In addition, health insurance status and the source of health care were found to relate to the types of health service that Korean American elderly chose to utilize. Better understanding of patterns of health service utilization may improve the quality of health care by increasing health providers' cultural sensitivity and facilitating adequate communication between Asian immigrant clients and their care providers. Implications for research and practice are discussed.     

Spirituality, Coping, and HIV Risk and Prevention in a Sample of Severely Mentally Ill Puerto Rican Women

Hispanics have been disproportionately impacted by HIV/AIDS. Although HIV risk is significantly elevated among severely mentally ill persons (SMI), the risk of infection appears to be even greater among those SMI who are Hispanic, reflecting the increased risk of HIV among Hispanics. We report on findings from the first 41 participants in a qualitative study examining the context of HIV risk and risk reduction strategies among severely mentally ill Puerto Rican women residents in northeastern Ohio. Individuals participated in a baseline interview, two follow-up interviews, and up to 100 hours of shadowing. Interviews and shadowing activities were recorded and analyzed using a grounded theory. The majority of individuals reported using identification with a religious faith. A large proportion of the participants reported that their religious or spiritual beliefs were critical to their coping, had influenced them to reduce risk, and/or provided them with needed social support. Several participants also reported having experienced rejection from their faith communities. The emphasis on spirituality among Puerto Rican SMI is consistent with previous research demonstrating the importance of spirituality in the Hispanic culture and reliance on spiritual beliefs as a mean of coping among SMI. Our results support the incorporation of spiritual beliefs into secular HIV prevention efforts. Loue is with the Department of Epidemiology and Biostatistics, Center for Minority Public Health, School of Medicine, Case Western Reserve University, Cleveland, OH, USA; Sajatovic is with the Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.     

Are immigrant populations aware about their oral health status? A study among immigrants from Ethiopia

Background  

Evidence from Western countries indicates that there are fundamental discrepancies between self-perceived illness of immigrants and the provision of health care, according to the Western bio-medical health service model. These need to be understood in the planning and implementation stages of public health care programs for new immigrants. The objectives of the present study were to investigate self-perceived versus clinically diagnosed dental and periodontal health status among immigrants from Ethiopia.     

Family and cultural influences on cervical cancer screening among immigrant Latinas in Miami-Dade County,USA

Cervical cancer disproportionately affects minorities, immigrants and low-income women in the USA, with disparities greatest among Latino immigrants. We examined barriers and facilitators to cervical cancer screening practices among a group of immigrant Latino women in Florida, USA. Between January and May 2013, six focus group discussions, involving 35 participants, were conducted among Hispanic women in Miami to explore their knowledge, beliefs about cervical cancer and facilitators and barriers to cervical cancer screening using a theoretical framework. The data showed that family support, especially from female relatives, was an important facilitator of screening and treatment. Women, however, reported prioritising family health over their own, and some expressed fatalistic beliefs about cancer. Major obstacles to receiving a Pap smear included fear that it might result in removal of the uterus, discomfort about being seen by a male doctor and concern that testing might stigmatise them as being sexually promiscuous or having a sexually transmitted disease. Targeted education on cancer and prevention is critically needed in this population. Efforts should focus on women of all ages since younger women often turn to older female relatives for advice.     

Knowledge of Cardiovascular Health Among Chinese, Korean and Vietnamese Immigrants to the US

Cardiovascular disease (CVD) is the leading cause of death among Asian Americans, the majority of whom are foreign-born. However, CVD and risk factor data is sparse for specific Asian immigrant populations. To assess knowledge and understanding of CVD and risk factors within Chinese, Korean and Vietnamese immigrant populations, we conducted eight focus groups of 77 participants between 36 and 84?years old. Participants correctly identified signs and symptoms for heart attacks while knowledge about stroke was incomplete. While poor diet, lack of exercise, older age, and high cholesterol were frequently discussed as risk factors, mechanisms perceived as contributing to heart disease were influenced primarily by non-Western paradigms. Non-Western remedies were discussed in detail among Chinese and Vietnamese participants. All participants desired more information, and identified barriers to effective communication with healthcare providers. A deeper understanding of beliefs and barriers faced by Asian immigrants can help guide health promotion efforts.     

Midwives¿ views on factors that contribute to health care inequalities among immigrants in Sweden: A qualitative study

ABSTRACT: INTRODUCTION: Ethnic and socioeconomic inequalities in the Swedish health care system have increased. Most indicators suggest that immigrants have significantly poorer health than native Swedes. The purpose of this study was to explore the views of midwives on the factors that contribute to health care inequality among immigrants. METHODS: Data were collected via semi-structured interviews with ten midwives. These were transcribed and related categories identified through content analysis. RESULTS: The interview data were divided into three main categories and seven subcategories. The category "Communication" was divided into subcategories "The meeting", "Cultural diversity and language barriers" and "Trust and confidence". The category "Potential barriers to the use of health care services" contained two subcategories, "Seeking health care" and "Receiving equal treatment". Finally, the category "Transcultural health care" had subcategories "Education on transcultural health care" and "The concept". CONCLUSIONS: This study suggests that midwives believe that health care inequality among immigrants can be the result of miscommunication which may arise due to a shortage of meeting time, language barriers, different systems of cultural beliefs and practices and limited patient-caregiver trust. Midwives emphasized that education level, country of origin and length of stay in Sweden play a role when an immigrant seeks health care. Immigrants face more difficulties when seeking health care and in receiving adequate levels of care. However, different views among the midwives were also observed. Some midwives were sensitive to individual and intra-group differences, while some others viewed immigrants as a group of "others". Midwives' beliefs about subgroup-specific health services vs. integrating immigrants' health care into mainstream health care services should be investigated further. Patients' perspective should also be considered.