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Impact of English Proficiency on Health Literacy in Older Korean Immigrants: Mediating Effects of Social Support and Acculturation

Journal of Immigrant and Minority Health (2023)Cite this article

Abstract

Limited English proficiency (LEP) is one of the most influencing factors of personal health literacy (PHL) in the older immigrant population. Over the years, the proportion of older Korean immigrants with LEP has not improved and it is still noted as a major barrier to PHL. Therefore, organizational approaches are needed to enhance the PHL of older immigrants with LEP. This study aims to find the mediating effect of social support and acculturation between LEP and PHL by conceptualizing social support and acculturation as an organizational health literacy strategy. Data from 244 older Korean immigrants living in the states of Alabama and Georgia, USA, were used to conduct the study. Korean version of the Multidimensional Scale of Perceived Social Support (MSPSS), East Asian Acculturation Measure (EAAM), and Health Literacy Survey-12 Questionnaires (HLS-Q12) were used to measure the variables. The path analysis was conducted to find the serial mediation effects of social support and acculturation. The results showed that 77.5% of the participants reported not having fluent English proficiency. English proficiency (β =− 0.21, p = 0.007), social support (β = 0.17, p = 0.004), and acculturation (β = 0.18, p = 0.011) significantly predicted the PHL, and social support (β = 0.04, p = 0.028) and acculturation (β = 0.14, p < 0.001) mediated the relationship between LEP and PHL. Discussion: Health-related organizations and communities are encouraged to provide external social support and acculturation opportunities to enhance PHL in older Korean immigrants with LEP.

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References

  1. Office of Disease Prevention and Health Promotion [ODPHP]. History of health literacy definitions. n.d. https://health.gov/healthypeople/priority-areas/health-literacy-healthy-people-2030/history-health-literacy-definitions. Accessed 11 Nov 2022.

  2. Parker R. Health literacy: a challenge for American patients and their health care providers. Health Promot Int. 2000;15(4):277–83. https://doi.org/10.1093/heapro/15.4.277.

    Article  Google Scholar 

  3. Bennett IM, et al. The contribution of health literacy to disparities in self-rated health status and preventive health behaviors in older adults. Ann Fam Med. 2009;7(3):204–11. https://doi.org/10.1370/afm.940.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Berkman ND, et al. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97–107. https://doi.org/10.7326/0003-4819-155-2-201107190-00005.

    Article  PubMed  Google Scholar 

  5. Bostock S, Steptoe A. Association between low functional health literacy and mortality in older adults: longitudinal cohort study. BMJ. 2012;344:e1602. https://doi.org/10.1136/bmj.e160.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cho YI, et al. Effects of health literacy on health status and health service utilization amongst the elderly. Soc Sci Med. 2008;66(8):1809–16. https://doi.org/10.1016/j.socscimed.2008.01.003.

    Article  PubMed  Google Scholar 

  7. Scott TL, et al. Health literacy and preventive health care use among Medicare enrollees in a managed care organization. Med Care. 2002;40(5):395–404. https://doi.org/10.1097/00005650-200205000-00005.

    Article  PubMed  Google Scholar 

  8. Becerra MB, et al. Determinants of low health literacy among Asian-American and Pacific Islanders in California. J Racial Ethn Health Disparities. 2015;2(2):267–73. https://doi.org/10.1007/s40615-015-0092-0.

    Article  PubMed  Google Scholar 

  9. Levin-Zamir D, et al. The association of health literacy with health behavior, socioeconomic indicators, and self-assessed health from a national adult survey in Israel. J Health Commun. 2016;21(sup2):61–8. https://doi.org/10.1080/10810730.2016.1207115.

    Article  PubMed  Google Scholar 

  10. Mantwill S, Monestel-Umaña S, Schulz P. The relationship between health literacy and health disparities: a systematic review. PLoS One. 2015;10(12):e0145455. https://doi.org/10.1371/journal.pone.0145455.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Protheroe J, et al. Health literacy, associated lifestyle and demographic factors in adult population of an English city: a cross-sectional survey. Health Expect. 2017;20:112–9. https://doi.org/10.1111/hex.12440.

    Article  PubMed  Google Scholar 

  12. Son YJ, et al. Factors influencing health literacy in community-dwelling adults. Korea J Health Promot. 2012;12(2):100–8.

    Google Scholar 

  13. Sentell T, Braun KL. Low health literacy limited English proficiency and health status in Asians Latinos and other racial/ethnic groups in California. J Health Commun. 2012;17(3):82–99. https://doi.org/10.1080/10810730.2012.712621.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Leyva M, Sharif I, Ozuah PO. Health literacy among Spanish-speaking Latino parents with limited English proficiency. Ambul Pediatr. 2005;5(1):56–9. https://doi.org/10.1367/A04-093R.1.

    Article  PubMed  Google Scholar 

  15. Gee GC, Ponce N. Associations between racial discrimination, limited English proficiency, and health-related quality of life among 6 Asian ethnic groups in California. Am J Public Health. 2010;100(5):888–95. https://doi.org/10.2105/AJPH.2009.178012.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Jang Y, Kim MT. Limited english proficiency and health service use in Asian Americans. J Immigr Minor Health. 2019;21(2):264–70. https://doi.org/10.1007/s10903-018-0763-0.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Rodriguez JA, et al. Disparities in telehealth use among California patients with limited english proficiency. Health Aff. 2021;40(3):487–95. https://doi.org/10.1377/hlthaff.2020.00823.

    Article  Google Scholar 

  18. Shi L, et al. The influence of english proficiency on access to care. Ethn Health. 2009;14(6):625–42. https://doi.org/10.1080/13557850903248639.

    Article  PubMed  Google Scholar 

  19. Jacobs EA, et al. Limited english proficiency and breast and cervical cancer screening in a multiethnic population. Am J Public Health. 2005;95(8):1410–6. https://doi.org/10.2105/AJPH.2004.041418.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Sentell T, et al. Colorectal cancer screening: low health literacy and limited english proficiency among Asians and Whites in California. J Health Commun. 2013;18(sup1):242–55. https://doi.org/10.1080/10810730.2013.825669.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Gracie B, Moon SS, Basham R. Inadequate health literacy among elderly immigrants: characteristics, contributing, and service utilization factors. J Hum Behav Soc Environ. 2012;22(7):875–95.

    Article  Google Scholar 

  22. Fernández-Gutiérrez M, et al. Health literacy interventions for immigrant populations: a systematic review. Int Nurs Rev. 2018;65(1):54–64. https://doi.org/10.1111/inr.12373.

    Article  PubMed  Google Scholar 

  23. Brach C. The journey to become a health literate organization: A snapshot of health system improvement. Stud Health Technol Inform. 2017;240:203–37. https://doi.org/10.3233/978-1-61499-790-0-203.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Shimkhada R, Tse HW, Ponce NA. Life satisfaction and social and emotional support among Asian American older adults. J Am Board Fam Med. 2022;35(1):203–5. https://doi.org/10.3122/jabfm.2022.01.210232.

    Article  PubMed  Google Scholar 

  25. Tennstedt SL, et al. How important is functional status as a predictor of service use by older people? J Aging Health. 1990;2(4):439–61. https://doi.org/10.1177/089826439000200402.

    Article  CAS  PubMed  Google Scholar 

  26. Chu CM. Immigrant children mediators (ICM): bridging the literacy gap in immigrant communities. New Rev Children’s Liter Librariansh. 1999;5(1):85–94. https://doi.org/10.1080/13614549909510616.

    Article  Google Scholar 

  27. Lee SYD, Gazmararian JA, Arozullah AM. Health literacy and social support among elderly Medicare enrollees in a managed care plan. J Appl Gerontol. 2006;25(4):324–37.

    Article  Google Scholar 

  28. Ciampa PJ, et al. The association of acculturation and health literacy, numeracy and health-related skills in Spanish-speaking caregivers of young children. J Immigr Minor Health. 2013;15(3):492–8. https://doi.org/10.1007/s10903-012-9613-7.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Mantwill S, Schulz P. Does acculturation narrow the health literacy gap between immigrants and non-immigrants—An explorative study. Patient Educ Couns. 2017;100(4):760–7. https://doi.org/10.1016/j.pec.2016.10.021.

    Article  PubMed  Google Scholar 

  30. Berry JW, Sam DL. The Cambridge handbook of acculturation psychology. Cambridge: Cambridge University Press; 2006.

    Google Scholar 

  31. Gibson MA. Immigrant adaptation and patterns of acculturation. J Human developmen. 2001;44(1):19–23. https://doi.org/10.1159/000057037.

    Article  Google Scholar 

  32. Jang Y, et al. A bidimensional model of acculturation for Korean American older adults. J Aging Stud. 2007;21(3):267–75. https://doi.org/10.1016/j.jaging.2006.10.004.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Dahlan R, et al. Impact of acculturation on oral health among immigrants and ethnic minorities: Systematic review. PLoS One. 2019;14(2):e0212891. https://doi.org/10.1371/journal.pone.0212891.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Lee H, Kim J, Han HR. Do cultural factors predict mammography behaviour among Korean immigrants in the USA? J Adv Nurs. 2009;65(12):2574–84. https://doi.org/10.1111/j.1365-2648.2009.05155.x.

    Article  PubMed  PubMed Central  Google Scholar 

  35. López L, et al. Association of acculturation and health literacy with prevalent dysglycemia and diabetes control among latinos in the boston area community health (BACH) survey. J Immigr Minor Health. 2016;18(6):1266–73. https://doi.org/10.1007/s10903-016-0362-x.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Mao W, et al. Acculturation and health behaviors among older Chinese immigrants in the United States: a qualitative descriptive study. Nurs Health Sci. 2020;22(3):714–22. https://doi.org/10.1111/nhs.12718.

    Article  PubMed  Google Scholar 

  37. Barry DT. Development of a new scale for measuring acculturation: the east asian acculturation measure (EAAM). J Immigr Health. 2001;3(4):193–7. https://doi.org/10.1023/A:1012227611547.

    Article  CAS  PubMed  Google Scholar 

  38. Chen X, Li M, Kreps GL. Acculturation and health literacy among Chinese speakers in the USA with limited english proficiency. J Racial Ethn Health Disparities. 2022;9(2):489–97. https://doi.org/10.1007/s40615-021-00979-9.

    Article  PubMed  Google Scholar 

  39. Soto Mas F, et al. The health literacy and ESL study: a community-based intervention for Spanish-speaking adults. J Health Commun. 2015;20(4):369–76. https://doi.org/10.1080/10810730.2014.965368.

    Article  PubMed  Google Scholar 

  40. Lee HY, et al. Health literacy as a social determinant of health in Asian American Immigrants: Findings from a population-based survey in california. J Gen Intern Med. 2015;30(8):1118–24. https://doi.org/10.1007/s11606-015-3217-6.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Sagong H, Yoon JY. Pathways among frailty, health literacy, acculturation, and social support of middle-aged and older Korean immigrants in the USA. Int J Environ Res Public Health. 2021;18(3):1245. https://doi.org/10.3390/ijerph18031245.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Finbråten HS, et al. Establishing the HLS-Q12 short version of the european health literacy survey questionnaire: latent trait analyses applying Rasch modelling and confirmatory factor analysis. BMC Health Serv Res. 2018;18(1):506. https://doi.org/10.1186/s12913-018-3275-7.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Kim SJ, Park DJ, Choi J. The relationship between sub-dimensions of health literacy and health-related behaviors among Korean adults. Health Soc Welfare Rev. 2019;39(1):334–64.

    Article  Google Scholar 

  44. Sørensen K, et al. Measuring health literacy in populations: illuminating the design and development process of the european health literacy survey questionnaire (HLS-EU-Q). BMC Public Health. 2013;13(1):948. https://doi.org/10.1186/1471-2458-13-948.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Shin JS, Lee YB. The effects of social supports on psychosocial well-being of the unemployed. Korean J Soc Welf. 1999;37:241–69. https://doi.org/10.2307/2136531.

    Article  Google Scholar 

  46. Zimet GD, et al. The multidimensional scale of perceived social support. J Pers Assess. 1988;52(1):30–41. https://doi.org/10.1207/s15327752jpa5201_2.

    Article  Google Scholar 

  47. Budiman A. Key findings about US immigrants. 2020. https://www.pewresearch.org/fact-tank/2020/08/20/key-findings-about-u-s-immigrants/. Accessed 15 Dec 2022.

  48. Jang Y, et al. Health vulnerability of immigrants with limited english proficiency: A study of older Korean Americans. J Am Geriatr Soc. 2016;64(7):1498–502. https://doi.org/10.1111/jgs.14199.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Kim G, et al. Limited english proficiency as a barrier to mental health service use: a study of Latino and Asian immigrants with psychiatric disorders. J Psychiatr Res. 2011;45(1):104–10. https://doi.org/10.1016/j.jpsychires.2010.04.031.

    Article  PubMed  Google Scholar 

  50. Kim G, et al. Vulnerability of older Latino and Asian immigrants with limited english proficiency. J Am Geriatr Soc. 2011;59(7):1246–52. https://doi.org/10.1111/j.1532-5415.2011.03483.x.

    Article  PubMed  Google Scholar 

  51. Liu YB, et al. Social support, health literacy, and health care utilization among older adults. Asia Pac J Public Health. 2019;31(4):359–66. https://doi.org/10.1177/101053951985167.

    Article  PubMed  Google Scholar 

  52. Lee H, Choi JK. Pathway to health literacy in Korean American immigrants: the mediating role of english proficiency. J Hum Behav Soc Environ. 2012;22(3):255–69. https://doi.org/10.1080/10911359.2012.655568.

    Article  Google Scholar 

  53. Lee HY, Lee J, Kim NK. Gender differences in health literacy among Korean adults: do women have a higher level of health literacy than men? Am J Mens Health. 2015;9(5):370–9. https://doi.org/10.1177/1557988314545485.

    Article  PubMed  Google Scholar 

  54. Park SY, Lee H, Kang M. Factors affecting health literacy among immigrants-systematic review. Eur J Public Health. 2018;28(4):214–83. https://doi.org/10.1093/eurpub/cky214.283.

    Article  CAS  Google Scholar 

  55. Guruge S, Sidani S, Illanko K. Comparing sources of social support among immigrant and non-immigrant older adults: Analysis of baseline data from the Canadian longitudinal study of aging. Perspect. 2021;42(1):18–29.

    Google Scholar 

  56. Bleakley H, Chin A. Age at arrival, English proficiency, and social assimilation among US immigrants. Am Econ J Appl Econ. 2010;2(1):165–92. https://doi.org/10.1257/app.2.1.165.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Fox M, Thayer Z, Wadhwa PD. Assessment of acculturation in minority health research. Soc Sci Med. 2017;176:123–32. https://doi.org/10.1016/j.socscimed.2017.01.029.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Li CC, Matthews AK, Dong X. The influence of health literacy and acculturation on cancer screening behaviors among older Chinese Americans. Gerontol Geriatr Med. 2018;4:2333721418778193. https://doi.org/10.1177/2333721418778193.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Canty-Mitchell J, Zimet GD. Psychometric properties of the Multidimensional Scale of Perceived Social Support in urban adolescents. Am J Community Psychol. 2000;28(3):391–400. https://doi.org/10.1023/A:1005109522457.

    Article  CAS  PubMed  Google Scholar 

  60. Chou KL. Assessing Chinese adolescents’ social support: the multidimensional scale of perceived social support. Pers Individ Differ. 2000;28(2):299–307. https://doi.org/10.1016/S0191-8869(99)00098-7.

    Article  Google Scholar 

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Authors and Affiliations

  1. College of Nursing, Auburn University, 710 South Donahue Drive Auburn, Auburn, AL, USA

    Hae Sagong & Pao-Feng Tsai

  2. Department of Nursing, Yeoju Institute of Technology, Yeoju, Republic of Korea

    Ah Ram Jang

  3. College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea

    Ju Young Yoon

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  1. Hae Sagong
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Contributions

JJY, ARJ, and HS contributed to the study conception and design. Data analysis was conducted by HS and data method considerations were reviewed by PFT. HS and PFT contributed to manuscript writing and revisions and all authors participated in reviewing the manuscript.

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Correspondence to Hae Sagong.

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Sagong, H., Tsai, PF., Jang, A.R. et al. Impact of English Proficiency on Health Literacy in Older Korean Immigrants: Mediating Effects of Social Support and Acculturation. J Immigrant Minority Health (2023). https://doi.org/10.1007/s10903-023-01530-0

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