Acculturation and Health Literacy Among Chinese Speakers in the USA with Limited English Proficiency.

BACKGROUND: Acculturation is an important factor that is uniquely associated with health literacy among racial/ethnic minorities. We examined the relationship between acculturation and health literacy among Chinese speakers in the USA who have limited English proficiency. Since language proficiency is an important subcomponent of acculturation, we also explored the relationship between English language proficiency and health literacy. METHODS: Our sample included 405 participants. To evaluate the appropriateness of the acculturation instrument to elicit valid data, we performed exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). We performed linear regressions to investigate the relationship between acculturation and health literacy. RESULTS: Our acculturation instrument can be divided into three factors: English language proficiency, interactions with family and friends, and interactions with neighbors. The acculturation measurement model exhibited good fit. Higher US acculturation was associated with lower Chinese information appraisal, higher English functional health literacy, and higher English information appraisal. Higher English language proficiency was positively associated with English functional health literacy and English information appraisal. There was no relationship between English language proficiency and Chinese health literacy. Neither acculturation nor English language proficiency was associated with empowerment. DISCUSSION: English language proficiency might play an important role in English functional health literacy and information appraisal. Developing and implementing English as a second language (ESL) curriculum in health promotion intervention programs can effectively improve English functional health literacy and information appraisal among populations with LEP.