Abstract
Native-born Chinese women’s experiences with medical help seeking in the U.S. is poorly understood, including how life phase affects it. Focus groups with middle-aged and older immigrant Chinese women explored: a) behaving assertively with doctors, b) strategies for assertiveness, c) characteristics of “ideal” doctors. Assertiveness was described as a reciprocal behavioral process between patient and doctor. Responsibility for initiating the process was seen as resting with doctors. Patient assertiveness goals included obtaining information and referrals. Strategies for achieving goals included not mentioning low-priority medical concerns in order to increase odds of obtaining referrals, and switching doctors when dissatisfied with communication. Older women reported refusing medical treatment due to language barriers. Cultural values, reported to be rooted in Confucianism, were identified by participants as shaping their help seeking. “Ideal” doctors were described as unhurried, and fully responsive to patient symptoms. Older women viewed “direct speaking” by doctors as always desirable around general information, and sometimes desirable around serious diagnoses. Older women perceived cultural differences with American-born Chinese providers. Findings are discussed in relation to continuity of care issues.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Adler, S., McGraw, S., & McKinlay, J. (1998). Patient assertiveness in ethnically diverse older women with breast cancer: challenging stereotypes of the elderly. Journal of Aging Studies, 12, 331–350.
Aroian, K. J., Wu, B., & Tran, T. V. (2005). Health care and social service use among Chinese immigrant elders. Research in Nursing & Health, 28(2), 95–105.
Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. (2003). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118(4), 293–302.
Candib, L. M. (2002). Truth telling and advance planning at the end of life: problems with autonomy in a multicultural world. Family Systems Health, 20, 213–228.
Federman, A. D., Cook, E. F., Phillips, R. S., Puopolo, A. L., Haas, J. S., Brennan, T. A., & Burstin, H. R. (2001). Intention to discontinue care among primary care patients: influence of physician behavior and process of care. Journal of General Internal Medicine, 16(10), 668–674.
Guo, Z., Levy, B., Hinton, L., Weitzman, P. F., & Levkoff, S. E. (2000). The power of labels: Recruiting dementia-affected Chinese-American elders and their caregivers. Journal of Mental Health & Aging, 6, 103–111.
Harris, K. (2003). How do patients choose physicians? Evidence from a national survey of enrollees in employment-related health plans. Health Services Research, 38, 711.
Herzlinger, R. (1999). Market driven health care. New York: Addison-Wesley.
Ho, C., Cui, X., Weitzman, P. F., & Levkoff, S. E. (2000). Stress and service use among minority caregivers of elders with dementia. Journal of Gerontological Social Work, 33, 67–88.
Hurworth, R. (1999). Can focus groups be rigorous? Paper presented at the annual meeting of the Association for Qualitative Research, Melbourne, Australia, July, 1999.
Lauderdale, D. S., Kuohung, V., Chang, S. L., & Chin, M. H. (2003). Identifying older Chinese immigrants at high risk for osteoporosis. Journal of General Internal Medicine, 18(7), 508–515.
Laveist, T. A., & Nuru-Jeter, A. (2002). Is doctor–patient race concordance associated with greater satisfaction with care? Journal of Health & Social Behavior, 43, 296–306.
Lee, T., Brugge, D., Francis, C., & Fisher, O. (2003). Asthma prevalence among inner-city Asian American schoolchildren. Public Health Reports, 118, 215–220.
Luborsky, M. R. (1994). The identification of themes and patterns. In J. Gubrium, & A. Sankar (Eds.), Qualitative methods in aging research (pp. 189–210). Thousand Oaks, CA: Sage.
Ma, J. (2000). National anti-cancer effort for APIs. Asianweek, 13, 8 April.
Mechanic, D., & Meyer, S. (2000). Concepts of trust among patients with serious illness. Social Science and Medicine, 51, 657–668.
Miles, M., & Huberman, A. (1984). Qualitative data analysis. Newbury Park, CA: Sage.
Morgan, D. L., & Krueger, R. A. (1993). When to use focus groups and why. In D. L. Morgan (Ed.), Successful focus groups: Advancing the state of the art (pp. 159–162). Newbury Park, CA: Sage.
Parkin, D., Muir, C., Whelan, S., Gao, Y., Ferlay, J., & Powell, J. (1993). Cancer incidence in five continents, Vol 6. Lyon, France: IARC.
Saha, S., Komaromy, M., Koepsell, T. D., & Bindman, A. B. (2005). Patient–physician racial concordance and the perceived quality and use of health care. American Family Physician, 71, 515–522.
Searight, H. R., & Gafford, J. (2005). Cultural diversity at the end of life: issues and guidelines for family physicians. American Family Physician, 71, 515–522.
Susan G. Komen Foundation (2007). Breast cancer statistics. Available at: http://www.komen.org. Accessed April 15, 2007.
Taylor, V. M., Hislop, T. G., Jackson, J. C., Shin-Ping Tu, S., Yasui, Y., Schwartz, S. M., Teh, C., Kuniyuki, A., Acorda, E., Marchand, A., & Thompson, B. (2002). A randomized controlled trial of interventions to promote cervical cancer screening among Chinese women in North America. Journal of the National Cancer Institute, 94(9), 670–677.
U.S. Census Bureau (2000). Census 2000 briefs and special reports. Found at: http://www.census.gov/population/www/cen2000/briefs.html. Accessed on October 26, 2006.
U.S. Department of Health and Human Services (1998). Racial and ethnic disparities in health. Washington (DC): Author.
Weitzman, P. F., Chang, G., & Reynoso, H. (2004). Middle-aged and older Latino American women in the patient–doctor interaction. Journal of Cross-Cultural Gerontology, 19, 221–239.
Weitzman, P. F., & Levkoff, S. E. (2008). Assertiveness in the medical encounter: Middle-aged and older African American women. Journal of Cross-Cultural Gerontology (in press).
Yeo, G., & Hikuyeda, N. (2000). Cultural issues in end-of-life decision making among Asians and Pacific Islanders in theUnited States. In K. Braun, J. H. Pietsch, & P. Blanchette (Eds.), Cultural issues in end-of-life decision making (pp. 101–125). Thousand Oaks, CA: Sage.
Yu, M. Y., & Wu, T. Y. (2005). Factors influencing mammography screening of Chinese American women. Journal of Obstetrical, Gynecological, & Neonatal Nursing, 34(3), 386–394.
Author information
Authors and Affiliations
Corresponding author
Additional information
Support for this study was provided to the first author by grants from the National Institute on Aging (1R03AG19103) and from the Center for Excellence in Women’s Health at Harvard Medical School.
Rights and permissions
About this article
Cite this article
Weitzman, P.F., Ballah, K. & Levkoff, S.E. Native-born Chinese Women’s Experiences in Medical Encounters in the U.S.. Ageing Int. 32, 128–139 (2008). https://doi.org/10.1007/s12126-008-9009-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12126-008-9009-0