Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
Journal of Community Health Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Agency for Healthcare Research and Quality. (2010). Chapter 4: Defining Language Need and Categories for Collection. In Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement (Publication # 10-0058-EF ed.). Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from http://www.ahrq.gov/research/findings/final-reports/iomracereport/reldata4a.html.

  2. Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10.

    Article  CAS  PubMed  Google Scholar 

  3. Baker, D. W. (2006). The meaning and the measure of health literacy. Journal of General Internal Medicine, 21(8), 878–883. doi:10.1111/j.1525-1497.2006.00540.x.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Derose, K. P., Gresenz, C. R., & Ringel, J. S. (2011). Understanding disparities in health care access—and reducing them—through a focus on public health. Health Affairs (Millwood), 30(10), 1844–1851. doi:10.1377/hlthaff.2011.0644.

    Article  Google Scholar 

  5. Green, A. R., Ngo-Metzger, Q., Legedza, A. T., Massagli, M. P., Phillips, R. S., & Iezzoni, L. I. (2005). Interpreter services, language concordance, and health care quality. Experiences of Asian Americans with limited English proficiency. Journal of General Internal Medicine, 20(11), 1050–1056. doi:10.1111/j.1525-1497.2005.0223.x.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ho, S. C. (1991). Health and social predictors of mortality in an elderly Chinese cohort. American Journal of Epidemiology, 133(9), 907–921.

    CAS  PubMed  Google Scholar 

  7. Hoeffel, E. M., Rastogi, S., Kim, M. O., & Shahid, H. (2012). The Asian Population: 2010. In U.S. Department of Commerce (Ed.) 2010 Census briefs. Retrieved from http://www.census.gov/prod/cen2010/briefs/c2010br-11.pdf.

  8. Hosmer, D. W., & Lemeshow, S. (1989). Applied logistic regression. New York: Wiley.

    Google Scholar 

  9. Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38(1), 21–37.

    Article  CAS  PubMed  Google Scholar 

  10. Institute of Medicine. (2004). Health literacy: A prescription to end confusion. Washington, DC: National Academics Press.

    Google Scholar 

  11. Jacobs, R. J., Lou, J. Q., Ownby, R. L., & Caballero, J. (2014). A systematic review of eHealth interventions to improve health literacy. Health Informatics Jounal [Epub ahead of print]. doi:10.1177/1460458214534092.

    Google Scholar 

  12. Jylha, M. (2009). What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Social Science and Medicine, 69(3), 307–316. doi:10.1016/j.socscimed.2009.05.013.

    Article  PubMed  Google Scholar 

  13. Kim, G., Worley, C. B., Allen, R. S., Vinson, L., Crowther, M. R., Parmelee, P., & Chiriboga, D. A. (2011). Vulnerability of older Latino and Asian immigrants with limited English proficiency. Journal of the American Geriatrics Society, 59(7), 1246–1252. doi:10.1111/j.1532-5415.2011.03483.x.

    Article  PubMed  Google Scholar 

  14. Kimbro, R. T., Gorman, B. K., & Schachter, A. (2012). Acculturation and self-rated health among Latino and Asian immigrants to the United States. Social Problems, 59(3), 341–363.

    Article  Google Scholar 

  15. Krochalk, P. C., Li, Y., & Chi, I. (2008). Widowhood and self-rated health among Chinese elders: The effect of economic condition. Australas Journal Ageing, 27(1), 26–32. doi:10.1111/j.1741-6612.2007.00269.x.

    Article  Google Scholar 

  16. Lee, H. Y., Rhee, T. G., Kim, N. K., & Ahluwalia, J. S. (2015). Health literacy as a social determinant of health in Asian American immigrants: findings from a population-based survey in California. Journal of General Internal Medicine, 30(8), 1118–1124. doi:10.1007/s11606-015-3217-6.

    Article  PubMed  Google Scholar 

  17. Leung, A. Y., Bo, A., Hsiao, H. Y., Wang, S. S., & Chi, I. (2014). Health literacy issues in the care of Chinese American immigrants with diabetes: A qualitative study. BMJ Open, 4(11), e005294. doi:10.1136/bmjopen-2014-005294.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Leung, K. K., Tang, L. Y., & Lue, B. H. (1997). Self-rated health and mortality in Chinese institutional elderly persons. Journal of Clinical Epidemiology, 50(10), 1107–1116.

    Article  CAS  PubMed  Google Scholar 

  19. Liao, Y., Bang, D., Cosgrove, S., Dulin, R., Harris, Z., Taylor, A., et al. (2011). Surveillance of health status in minority communities—Racial and Ethnic Approaches to Community Health Across the U.S. (REACH U.S.) Risk Factor Survey, United States, 2009. MMWR Surveillance Summaries, 60(6), 1–44.

    Google Scholar 

  20. Lor, M., Xiong, P., Schwei, R. J., Bowers, B. J., & Jacobs, E. A. (2015). Limited English proficient Hmong- and Spanish-speaking patients’ perceptions of the quality of interpreter services. International Journal of Nursing Studies [Epub ahead of print]. doi:10.1016/j.ijnurstu.2015.03.019.

    PubMed  Google Scholar 

  21. Morris, N. S., MacLean, C. D., Chew, L. D., & Littenberg, B. (2006). The single item literacy screener: Evaluation of a brief instrument to identify limited reading ability. BMC Family Practice, 7, 21. doi:10.1186/1471-2296-7-21.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Nguyen, B. H., McPhee, S. J., Stewart, S. L., & Doan, H. T. (2008). Colorectal cancer screening in Vietnamese Americans. Journal of Cancer Education, 23(1), 37–45. doi:10.1080/08858190701849395.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Nguyen, B. H., Stewart, S. L., Nguyen, T. T., Bui-Tong, N., & McPhee, S. J. (2015). Effectiveness of lay health worker outreach in reducing disparities in colorectal cancer screening in Vietnamese Americans. American Journal of Public Health, 105(10), 2083–2089. doi:10.2105/AJPH.2015.302713.

    Article  PubMed  Google Scholar 

  24. Nguyen, T. T., Love, M. B., Liang, C., Fung, L. C., Nguyen, T., Wong, C., et al. (2010). A pilot study of lay health worker outreach and colorectal cancer screening among Chinese Americans. Journal of Cancer Education, 25(3), 405–412. doi:10.1007/s13187-010-0064-3.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Pew Social & Demographic Trends. (2012). The rise of Asian Americans. Retrieved from http://www.pewsocialtrends.org/files/2012/06/SDT-The-Rise-of-Asian-Americans-Full-Report.pdf.

  26. Ponce, N. A., Hays, R. D., & Cunningham, W. E. (2006). Linguistic disparities in health care access and health status among older adults. Journal of General Internal Medicine, 21(7), 786–791. doi:10.1111/j.1525-1497.2006.00491.x.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Powers, B. J., Trinh, J. V., & Bosworth, H. B. (2010). Can this patient read and understand written health information? JAMA, 304(1), 76–84. doi:10.1001/jama.2010.896.

    Article  CAS  PubMed  Google Scholar 

  28. Remler, D. K., Teresi, J. A., Weinstock, R. S., Ramirez, M., Eimicke, J. P., Silver, S., & Shea, S. (2011). Health care utilization and self-care behaviors of Medicare beneficiaries with diabetes: Comparison of national and ethnically diverse underserved populations. Population Health Management, 14(1), 11–20. doi:10.1089/pop.2010.0003.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Sentell, T., & Braun, K. L. (2012). Low health literacy, limited English proficiency, and health status in Asians, Latinos, and other racial/ethnic groups in California. Journal Health Communication, 17(Suppl 3), 82–99. doi:10.1080/10810730.2012.712621.

    Article  PubMed  Google Scholar 

  30. Sentell, T. L., Tsoh, J. Y., Davis, T., Davis, J., & Braun, K. L. (2015). Low health literacy and cancer screening among Chinese Americans in California: A cross-sectional analysis. BMJ Open, 5(1), e006104. doi:10.1136/bmjopen-2014-006104.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Simon, M. A., Li, Y., & Dong, X. (2014). Levels of health literacy in a community-dwelling population of Chinese older adults. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 69(Suppl 2), S54–S60. doi:10.1093/gerona/glu179.

    Article  Google Scholar 

  32. Teh, J. K., Tey, N. P., & Ng, S. T. (2014). Ethnic and gender differentials in non-communicable diseases and self-rated health in Malaysia. PLoS ONE, 9(3), e91328. doi:10.1371/journal.pone.0091328.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Todorova, I. L., Tucker, K. L., Jimenez, M. P., Lincoln, A. K., Arevalo, S., & Falcon, L. M. (2013). Determinants of self-rated health and the role of acculturation: Implications for health inequalities. Ethnicity and Health, 18(6), 563–585. doi:10.1080/13557858.2013.771147.

    Article  PubMed  Google Scholar 

  34. U.S. Bureau of the Census. (2014). 2011–2013 3-year American community survey. Retrieved from http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_13_3YR_S0201&prodType=table.

  35. U.S. Bureau of the Census. (2015). Annual estimates of the resident population by Sex, race alone or in combination, and Hispanic origin for the United States, States, and counties: April 1, 2010 to July 1, 2014. Retrieved from http://www.census.gov/popest/data/index.html.

  36. Viswanathan, M., Kraschnewski, J. L., Nishikawa, B., Morgan, L. C., Honeycutt, A. A., Thieda, P., et al. (2010). Outcomes and costs of community health worker interventions: A systematic review. Medical Care, 48(9), 792–808. doi:10.1097/MLR.0b013e3181e35b51.

    Article  PubMed  Google Scholar 

  37. Viswanathan, M., Kraschnewski, J., Nishikawa, B., Morgan, L. C., Thieda, P., Honeycutt, A., Lohr, K. N., & Jonas, D. (2009). Outcomes of community health worker interventions. Evid Rep Technol Assess (Full Rep)(181), 1–144, A141-142, B141-114, passim.

  38. Zack, M. M. (2013). Health-related quality of life—United States, 2006 and 2010. MMWR Surveillance Summaries, 62(Suppl 3), 105–111.

    Google Scholar 

Download references

Acknowledgments

The authors wish to express their gratitude to Corina Liew, Christina Nip, Ying Wang, and Hy Lam; the Sức Khỏe Là Vàng!—UCSF Vietnamese Community Health Promotion Project; and the Asian American Network for Cancer Awareness, Research and Training-San Francisco (SF-ANNCART) for their valuable contributions in data collection and study implementation.

Funding

This research was supported by the National Cancer Institute (5R01CA138778, PI: Nguyen, T). Additional support was provided by the National Cancer Institute’s Center to Reduce Cancer Health Disparities through Grant 1U54153499 to the Asian American Network for Cancer Awareness, Research, and Training. The content is solely the responsibility of the authors and does not reflect the official views of the funders.

Author information

Authors and Affiliations

  1. Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave (TRC-0984), San Francisco, CA, 94143, USA

    Janice Y. Tsoh & Elaine Chan

  2. Asian American Research Center for Health (ARCH), San Francisco, CA, USA

    Janice Y. Tsoh, Gem M. Le, Rena J. Pasick, Adam Burke, Jun Wang & Tung T. Nguyen

  3. Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, HI, USA

    Tetine Sentell

  4. Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, CA, USA

    Ginny Gildengorin, Gem M. Le, Ching Wong, Stephen J. McPhee & Tung T. Nguyen

  5. NICOS Chinese Health Coalition, San Francisco, CA, USA

    Kent Woo

  6. Health Education Department, Chinatown Public Health Center, San Francisco, CA, USA

    Lei-Chun Fung

  7. University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA

    Rena J. Pasick

  8. Division of Biostatistics, University of California, Davis, CA, USA

    Susan Stewart

  9. Health Education/Holistic Health Studies, San Francisco State University, San Francisco, CA, USA

    Adam Burke

  10. Academy of Chinese Culture and Health Sciences, Oakland, CA, USA

    Jun Wang

Authors
  1. Janice Y. Tsoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tetine Sentell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ginny Gildengorin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gem M. Le
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Elaine Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lei-Chun Fung
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rena J. Pasick
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Susan Stewart
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ching Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kent Woo
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Adam Burke
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Jun Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Stephen J. McPhee
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Tung T. Nguyen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Janice Y. Tsoh.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Standard

The Institutional Review Boards of the University of California San Francisco and San Francisco State University approved all study procedures.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tsoh, J.Y., Sentell, T., Gildengorin, G. et al. Healthcare Communication Barriers and Self-Rated Health in Older Chinese American Immigrants. J Community Health 41, 741–752 (2016). https://doi.org/10.1007/s10900-015-0148-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10900-015-0148-4

Keywords

Search

Navigation