Lost in Translation: Impact of Language Barriers and Facilitators on the Health Care of Asian Americans Living with HIV.

Language barriers are major obstacles that Asian American immigrants face when accessing health care in the USA. This study was conducted to explore the impact of language barriers and facilitators on the health care of Asian Americans. Qualitative, in-depth interviews and quantitative surveys were conducted with 69 Asian Americans (Chinese, Filipino, Japanese, Malaysian, Indonesian, Vietnamese, and mixed Asian backgrounds) living with HIV (AALWH) in three urban areas (New York, San Francisco, and Los Angeles) in 2013 and from 2017 to 2020. The quantitative data indicate that language ability is negatively associated with stigma. Major themes emerged related to communication, including the impact of language barriers on HIV care and the positive impact of language facilitators-family members/friends, case managers, or interpreters-who can communicate with healthcare providers in the AALWH's native language. Language barriers negatively impact access to HIV-related services and thus result in decreased adherence to antiretroviral therapy, increased unmet healthcare needs, and increased HIV-related stigma. Language facilitators enhanced the connection between AALWH and the healthcare system by facilitating their engagement with health care providers. Language barriers experienced by AALWH not only impact their healthcare decisions and treatment choices but also increase levels of external stigma which may influence the process of acculturation to the host country. Language facilitators and barriers to health services for AALWH represent a target for future interventions in this population.

A comparison of physical activity environments between South Asians and white Caucasians with coronary heart disease.

South Asians (SA) are predisposed to developing premature coronary heart disease (CHD), partly due to the early onset of classic risk factors, including physical inactivity. The nature of physical activity (PA) environments in South Asians in Canada remains unknown. Our objective was to examine differences in PA environments for South Asian vs White Caucasian (WC) CHD patients. In a cross-sectional study, 2657 hospitalized CHD patients in Ontario completed The Perceived Environments Related to Physical Activity Questionnaire to assess their home and neighborhood environment, perceived neighborhood safety and availability of recreational facilities. Patients self-reporting their ethnocultural background as WC (N = 1301, 48.6%) or SA (N = 171, 6.4%) were included in this study. South Asians were significantly younger, had lower body mass index, higher levels of education, lower income, were less likely to smoke and reside rurally, and were more likely to be married, have diabetes mellitus and have experienced prior myocardial infarction (MI) than WC patients. South Asians also had lower availability of home exercise equipment and perceived convenience of local PA facilities, but better and safer neighborhood environments than WC patients. Multivariate analyses revealed that SA ethnocultural background remained significantly related to reduced availability of home exercise equipment and fewer convenient local PA facilities. Since physical inactivity is an important CHD risk factor, and SA ethnocultural background is associated with high CHD risk, this may represent a novel target for risk reduction. Thus, further research is required to optimize SA awareness of the need for PA, and access to equipment and facilities.

Variation in patient perceptions of healthcare provider endorsement of cardiac rehabilitation.

PURPOSE: Cardiac rehabilitation (CR) is significantly underutilized. However, physician endorsement promotes greater patient utilization. This study examined perceptions of provider endorsement by patients (1) of sociodemographic groups who are often less represented in CR and by clinical indication and (2) by type of healthcare provider and place of referral. METHODS: Referred cardiac (N = 1156) inpatients from 11 hospitals across Ontario completed a sociodemographic survey inhospital and a mailed followup survey 1 year later. Respondents self-reported perceived healthcare provider endorsement of CR on a 5-point Likert scale, type of referring healthcare provider, and where the referral was initiated. RESULTS: The overall perceived strength of healthcare provider endorsement to CR was 3.75 ± 1.15. Patients who perceived greater endorsement were significantly more likely to enrol (OR = 2.07) and attend a greater percentage of CR sessions (P < .001). Student t tests showed that women (P < .01), those older than 65 years (P < .01), with lower annual family income (P < .001), less than high school education (P < .01), who were retired (P < .01), or had lower subjective social status (P < .01) reported significantly lower perceived healthcare provider endorsement of CR than their respective counterparts. Perception of CR endorsement did not differ significantly on the basis of location of referral initiation (P ≥ .05), but those who discussed CR with family doctors (P < .05), cardiologists (P < .05), or cardiac surgeons (P < .01) reported significantly greater endorsement than those discussing CR with nurses. CONCLUSIONS: Given the proven benefits of CR, all healthcare providers are recommended to universally and strongly encourage CR participation among their patients in order to optimize utilization and subsequent recovery.

The role of systematic inpatient cardiac rehabilitation referral in increasing equitable access and utilization.

BACKGROUND: While systematic referral strategies have been shown to significantly increase cardiac rehabilitation (CR) enrollment to approximately 70%, whether utilization rates increase among patient groups who are traditionally underrepresented has yet to be established. This study compared CR utilization based on age, marital status, rurality, socioeconomic indicators, clinical risk, and comorbidities following systematic versus nonsystematic CR referral. METHODS: Coronary artery disease inpatients (N = 2635) from 11 Ontario hospitals, utilizing either systematic (n = 8 wards) or nonsystematic referral strategies (n = 8 wards), completed a survey including sociodemographics and activity status. Clinical data were extracted from charts. At 1 year, 1680 participants completed a mailed survey that assessed CR utilization. The association of patient characteristics and referral strategy on CR utilization was tested using χ. RESULTS: When compared to nonsystematic referral, systematic strategies resulted in significantly greater CR referral and enrollment among obese (32 vs 27% referred, P = .044; 33 vs 26% enrolled, P = .047) patients of lower socioeconomic status (41 vs 34% referred, P = .026; 42 vs 32% enrolled, P = .005); and lower activity status (63 vs 54% referred, P = .005; 62 vs 51% enrolled, P = .002). There was significantly greater enrollment among those of lower education (P = .04) when systematically referred; however, no significant differences in degree of CR participation based on referral strategy. CONCLUSION: Up to 11% more socioeconomically disadvantaged patients and those with more risk factors utilized CR where systematic processes were in place. They participated in CR to the same high degree as their nonsystematically referred counterparts. These referral strategies should be implemented to promote equitable access.