RESUMEN
Responding to the underutilization of mental health services in Asian American communities, we examined factors associated with their willingness to use mental health counseling. Applying Andersen's Behavioral Health Service Model, we focused on the role of mental health needs and prior use of mental health counseling in shaping the attitudes toward mental health counseling of diverse groups of Asian Americans. We conducted a secondary analysis of data from 2,609 Asian Americans aged 18 or older who participated in the Asian American Quality of Life (AAQoL) survey conducted in central Texas. Logistic regression models of willingness to use mental health counseling were tested with predisposing (age, gender, marital status, education, nativity, and English-speaking ability), mental health needs (mental distress and self-rated mental health) and enabling (prior use of mental health counseling) variables. About 67% of the overall sample indicated their willingness to use mental health counseling. Individuals who met the criteria for mental distress showed 17% lower odds of willingness to use mental health counseling. The enabling role of prior use of mental health counseling was supported; those who had used counseling were over three times more likely to be willing to use counseling in the future than their counterparts without such an experience. Given the inverse association between mental health needs and the willingness to use mental health counseling, further attention should be paid to improving Asian Americans' recognition of mental health symptoms and awareness of the benefit of mental health services. The enabling role of prior use of counseling also highlights the importance of increasing the exposure to mental health services for Asian Americans. In efforts to promote mental health literacy, reduce cultural stigma, and advocate for mental health service use, consideration of cultural and linguistic diversity within the Asian American population is imperative.
Asunto(s)
Asiático , Consejo , Servicios de Salud Mental , Salud Mental , Humanos , Asiático/psicología , Asiático/estadística & datos numéricos , Femenino , Masculino , Adulto , Persona de Mediana Edad , Servicios de Salud Mental/estadística & datos numéricos , Anciano , Adolescente , Adulto Joven , Aceptación de la Atención de Salud/etnología , Aceptación de la Atención de Salud/psicología , Calidad de Vida , Texas , Encuestas y CuestionariosRESUMEN
Dementia caregiving involves a challenging and complex process, especially for immigrant families. Using a qualitative method, this study provides an in-depth exploration of caregiving experiences among Korean American caregivers of people living with dementia. Based on various sampling strategies, 16 Korean American caregivers of family members/relatives with dementia were recruited in the greater Los Angeles area. Guided by the stress process model and the constant comparative method, themes and subthemes were derived and categorized into four domains: (1) background/context; (2) perception/appraisal; (3) resources/coping, and (4) caregiver burden/reward. Findings suggest that intervention efforts should focus on educating and training dementia caregivers.
RESUMEN
Using data from a sample of older Korean Americans (n = 2,150), we examined the prevalence and associated factors of physical, emotional, and financial mistreatment. Given the importance of contextual factors, we examined the effect of immigration-related (years in the U.S. and acculturation) and interpersonal/community-related (family solidarity, social network, and ethnic community social cohesion) factors in addition to sociodemographic and health-related characteristics. The rate of experiencing physical, emotional, and financial mistreatment during the past year was 3%, 37.9%, and 16.1%, respectively. Younger age and lower family solidarity were common risk factors for emotional and financial mistreatment. The experience of emotional mistreatment was also more likely among females and those with higher level of acculturation, smaller social networks, and lower ethnic community social cohesion. Chronic disease was an additional risk factor for financial mistreatment. The findings suggest targeted prevention and intervention strategies for elder mistreatment.
RESUMEN
Using data from Korean-American residents (N = 343) in subsidized senior housing in the Los Angeles area, we examined the effect of peer bullying on mental health. About 18% of the sample had been a target of bullying, and over 31% had witnessed someone being bullied. Being a target of bullying was a significant predictor for both depressive symptoms and anxiety, whereas witnessing other residents being bullied was a significant predictor for anxiety only. Findings shed light on the adverse mental health impacts of peer bullying among ethnic minority older residents in senior housing.
Asunto(s)
Asiático , Acoso Escolar , Grupo Paritario , Humanos , Los Angeles , Anciano , Masculino , Femenino , Acoso Escolar/psicología , Asiático/psicología , Anciano de 80 o más Años , Salud Mental , Depresión/etnología , Depresión/psicología , Viviendas para Ancianos , Ansiedad/psicología , Ansiedad/etnologíaRESUMEN
OBJECTIVES: We examined how the association between cognitive performance and cognitive health appraisal would be moderated by vision and/or hearing impairment. METHODS: Data were collected from 315 older Korean-American residents in subsidized senior housing in Los Angeles (M age = 79.4 years). Linear regression models examined the direct and interactive effects of cognitive performance, vision impairment, and hearing impairment on cognitive health appraisal. RESULTS: Negative appraisal of cognitive health was associated with lower cognitive performance and poorer ratings for vision and hearing. Moreover, we found a significant interaction between cognitive performance and hearing impairment (ß = .13, p < .05), as well as a three-way interaction among cognitive performance, vision impairment, and hearing impairment (ß = .12, p < .05). DISCUSSION: The association between objective and subjective measures of cognition was weakened when hearing was impaired. Such a pattern was further evident when both vision and hearing were impaired.
RESUMEN
BACKGROUND: In California, preventive dental care is covered by Medi-Cal (California's Medicaid program). However, many beneficiaries do not use their dental benefits. Given that a lack of knowledge about oral health and insurance coverage contributes to this underutilization, promoting the use of dental benefits among eligible individuals via an educational program is imperative. Responding to the particular needs of older immigrants with limited English proficiency, we developed a digital oral health intervention for older Korean-American Medi-Cal enrollees in Los Angeles. This educational intervention is designed to be delivered via computers and the Internet. It consists of a 15-min self-running PowerPoint presentation narrated in Korean with links to additional information on the Internet. The slides contain information about the basic etiology of oral diseases, oral hygiene, common myths about oral health and dental care, Medi-Cal coverage of preventive dental care, and how to find a dental clinic. METHODS: We pilot tested the intervention with 12 participants to examine its feasibility and acceptability. We also obtained participants' qualitative feedback about the intervention. RESULTS: A post-intervention quantitative assessment yielded high participant satisfaction and improved oral health and dental care knowledge. Participant responses to the intervention yielded four themes: (1) content and structure, (2) linguistic and cultural aspects, (3) delivery mode, and (4) additional concerns and suggestions. CONCLUSIONS: Our findings confirm the intervention's feasibility and acceptability and suggest further refinement.
Asunto(s)
Atención Odontológica , Medicaid , Estados Unidos , Humanos , Los Angeles , República de Corea , CaliforniaRESUMEN
We conducted an analysis to identify factors influencing the use of traditional complementary and alternative medicine (TCAM), with a particular emphasis on ethnic variations. Using the 2015 Asian American Quality of Life survey (N = 2,609), logistic regression analyses were performed, considering acculturation, health status, healthcare accessibility/utilization, and socio-demographic factors. Ethnicity, specifically being Chinese or Korean Americans, having chronic medical conditions, experiencing unmet healthcare needs, and having regular check-ups were significant predictors of TCAM use among Asian Americans as a whole. However, when we delved into sub-ethnic groups, different patterns were found. Among Vietnamese and Filipino Americans, having unmet healthcare needs emerged as the most prominent predictor of TCAM use. Furthermore, acculturation level and English proficiency were significant in predicting Vietnamese and Filipino Americans' TCAM use, with the direction varying by sub-ethnicity. Being old emerged as a predictor of TCAM use for Chinese, Indian, Korean, and 'other' Americans. Our findings underscore the importance of adopting an ethnically sensitive approach when addressing the healthcare needs of diverse Asian American populations.
Asunto(s)
Aculturación , Asiático , Terapias Complementarias , Humanos , Asiático/estadística & datos numéricos , Femenino , Masculino , Terapias Complementarias/estadística & datos numéricos , Persona de Mediana Edad , Adulto , Anciano , Estados Unidos , Factores Socioeconómicos , Estado de Salud , Accesibilidad a los Servicios de Salud , Factores de Edad , Aceptación de la Atención de Salud/etnología , Factores Sociodemográficos , Adulto Joven , Vietnam/etnología , Filipinas/etnología , Calidad de Vida , Etnicidad/estadística & datos numéricosRESUMEN
BACKGROUND: The Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) is a tool that systematically guides decision-making and reporting of adaptations made to evidence-based interventions. Using FRAME, we documented the process and outcomes of adapting the Savvy Caregiver Program (SCP) for Korean American dementia caregivers. METHODS: Sequential adaptation was initiated with linguistic attunement, followed by pilot implementation and full adaptation. Our data-driven adaptation with multiple data sources and a feedback loop among multiple stakeholders yielded a total of 32 modifications, and each was coded according to the eight domains of FRAME: (1) what was modified, (2) who participated in recommending and deciding the modification to be made, (3) when the modification occurred, (4) whether the modification was planned, (5) whether the modification was fidelity-consistent, (6) whether the modification was temporary, (7) at what level of delivery, the modification was made, and (8) why the modification was made. RESULTS: The areas of adaptation were evenly distributed across context (37.5%), content (31.2%), and training (31.2%). The primary reasons for modification were for engagement (62.5%), followed by fit with recipients (43.8%) and outcome improvement (31.1%). About 66% of the modifications were applied to the entire target group, and all modifications were fidelity-consistent. CONCLUSIONS: The FRAME categorization provided a detailed understanding of the process and nature of adapting the SCP and served as a foundation for further implementation and scale-up. FRAME not only serves as a guide for adapting evidence-based interventions but also promotes their replicability and scalability.
Asunto(s)
Asiático , Cuidadores , Asistencia Sanitaria Culturalmente Competente , Humanos , Cuidadores/educaciónRESUMEN
This study examined how different living/eating arrangements were associated with loneliness and depressive symptoms among older Korean immigrants. We examined gender differences considering: (1) patterns of living/eating arrangements and their relations with loneliness and mental distress and (2) indirect effect of living/eating arrangements on mental distress through feeling lonely. Data were drawn from the Study of Older Korean Americans that surveyed older; Korean immigrants during 2017-2018 (N = 2150). Living/eating arrangements were classified in the combination of four categores. Using the PROCESS macro, we tested gender differences in the mediation effect of loneliness on the relationship between living/eating arrangements and mental distress while controlling for background/health characteristics and social connectedness-related variables. The mediating role of loneliness was manifested differentially between men and women. By administering simple measures of living/eating arrangements, practitioners could potentially identify key targets to improve social and mental well-being, particularly among older immigrants with limited resources.
Asunto(s)
Emigrantes e Inmigrantes , Soledad , Masculino , Humanos , Femenino , Factores Sexuales , Emociones , República de CoreaRESUMEN
BACKGROUND AND OBJECTIVES: Adopting preventive behaviors is crucial to avoiding coronavirus disease 2019 (COVID-19) infection, and perceived anxiousness may influence such behaviors among older adults and their caregivers. This study investigated the relationships between perceived anxiousness about COVID-19 and preventive behaviors in older adult-caregiver dyads. RESEARCH DESIGN AND METHODS: A cross-sectional study was conducted using 1,565 older adult-caregiver dyads from the 2020 National Health and Aging Trend Study (NHATS)/National Study of Caregiving (NSOC) COVID-19 Supplements data. Actor-partner interdependence models were estimated to examine the associations between older adults' and family caregivers' perceived anxiousness about COVID-19 and their engagement in personal (e.g., wearing masks, washing hands) and social (e.g., avoiding contact with friends, limiting grocery shopping) preventive behaviors. Separate models were estimated based on older adults' dementia status. RESULTS: We found significant actor effects of anxiousness about COVID-19 on preventive behaviors of both older adults and caregivers in nondementia dyads. The anxiousness about COVID-19 of older adults had significant partner effects on both personal and social preventive behaviors of caregivers, whereas caregivers' anxiousness about COVID-19 only had a significant partner effect on social preventive behaviors of older adults. No significant partner effect was found in dementia dyads. DISCUSSION AND IMPLICATIONS: Our findings highlight the critical role of caregivers in promoting older adults' health behaviors during the COVID-19 pandemic and maintaining mental well-being of older adults. The study also implies future efforts to explore the dyadic relationship of dementia care dyads in promoting health behaviors and mental health.
Asunto(s)
COVID-19 , Demencia , Humanos , Anciano , Cuidadores/psicología , Estudios Transversales , Pandemias , Calidad de Vida/psicología , COVID-19/prevención & control , Ansiedad/psicología , Demencia/psicologíaRESUMEN
Because subjective cognitive decline (SCD) manifests before the clinical and irreversible onset of dementia, efforts to address SCD are imperative for the early identification and prevention of dementia. For people who actually experience SCD, having a usual source of care may be an important catalyst for addressing memory issues. This study investigates the relationship between having a usual source of care and the discussion of SCD with healthcare providers, while taking into account racial and ethnic differences. The pooled 2019-2020 Behavioral Risk Factor Surveillance System (BRFSS) from 47 states in the U.S. was used. The sample included 7900 individuals aged 50 and older who reported significant cognitive decline. Using logistic regression with state-level clustering, we found that those with a usual source of healthcare were almost twice as more likely to discuss memory loss with a healthcare provider. In order to test for the multiplicative effects, we included an interaction term between each race category and having a primary care provider (PCP). There was a significant interaction effect between Hispanic ethnicity and having a PCP (OR = 0.25, p < 0.05). While non-Hispanic respondents who had a PCP had a higher probability of discussing memory issues with a healthcare provider (42% vs. 25%), Hispanic respondents with a PCP were less likely to discuss their memory loss with a healthcare provider (36% vs. 49%). The study adds to the growing literature on the vital role of the primary care service in provision of service to those with cognitive decline, while revealing ethnic disparity in memory-loss-related communication with healthcare providers in a primary care setting.
RESUMEN
BACKGROUND: Primary family caregivers of older people with chronic care conditions are highly vulnerable to social isolation and psychological strains such as depression and anxiety due to their demanding responsibilities. This study examines how social isolation mediates the relationship between caregiving stress and mental health symptoms of primary family caregivers. METHODS: The analytic sample included 881 primary caregivers of older adults from the 2015 and 2017 National Study of Caregiving (NSOC). Social isolation was measured using a composite structure that includes objective social disconnectedness and subjective loneliness. Two-wave mediation models were estimated to examine longitudinally if social isolation mediated the relationship between caregiving stress (subjective & objective stress) and mental health symptoms (depression & anxiety) of primary caregivers. RESULTS: The study findings indicate that both subjective (ß = 0.32, p < 0.001) and objective stress (ß = 0.21, p = 0.003) have direct effects on depression among primary caregivers. Social isolation was found to only mediate the relationship between objective stress and depression (ß = 0.18, p < 0.001). In contrast, no significant direct and indirect pathway was found in the anxiety model. CONCLUSIONS: The study demonstrates the internal mechanism where objective strains of caregiving make family caregivers socially isolated, which in turn leads to increased symptoms of depression. Future interventions and practices aimed at improving the psychological well-being of family caregivers should prioritize strategies aimed at increasing social engagement, particularly for those with heavy caregiver burdens.
RESUMEN
OBJECTIVES: Language accommodation is indispensable in making evidence-based interventions available and accessible to ethnic minorities with limited English proficiency. As part of the larger effort to culturally adapt the Savvy Caregiver Program for Korean American dementia caregivers, we first conducted linguistic adaptation, and the present study reports the preliminary findings on participants' changes in depressive Symptoms. METHODS: The linguistically adapted program was delivered to two small groups of Korean American dementia caregivers (total n = 13) by two Savvy-certified Korean-speaking trainers. Participants' depressive symptoms were assessed at three time points (pre-intervention, immediate post-intervention, and 6-month follow-up). RESULTS: Following the intervention, participants exhibited lowered depressive symptoms (t = 8.64, p < .001, Cohen's d = .89). This benefit was sustained at 6-month follow-up. CONCLUSIONS: Findings suggest that the therapeutic benefit of the Savvy Caregiver Program could potentially be shared with linguistic minorities when delivered in their native language. CLINICAL IMPLICATIONS: Although limited in its scope and nature, the pilot study with linguistic adaptation sheds light on efforts to close the gap in the evidence-based intervention delivery.
RESUMEN
Considering that individuals' health information can enable their adoption of health behaviors, we examined the use of health information sources related to COVID-19 and its association with preventive behaviors in a sample of older residents in Seoul, South Korea (N = 400, M age = 76.1 years). Latent profile analysis of 12 sources of health information representing conventional media, online sources, interpersonal networks, and health professionals or authorities yielded a 4-group typology: limited, moderate/traditional, moderate/digital, and diverse. In a multivariate model with the diverse group as a reference, the limited group (B = -4.48, SE = 1.14, p < .001) and the moderate/digital group (B = -2.73, SE = 0.76, p < .001) were associated with lower adherence to COVID-19 preventive behaviors. Our findings support the heterogeneity in the use of health information sources and the hypothesis that groups with restricted sources of health information would report less desirable behaviors. The findings also underscored the importance of proper use of digital health information. Efforts should be made not only to help older adults with low education access diverse sources of health information, including digital sources, but also to empower them to build digital and health literacy.
Asunto(s)
COVID-19 , Fuentes de Información , Humanos , Anciano , Seúl , COVID-19/epidemiología , COVID-19/prevención & control , República de Corea/epidemiología , Conductas Relacionadas con la SaludRESUMEN
The present study explored how individual- and neighborhood-level factors contribute to predicting the use of preventive health care in a sample of Asian Americans. The cross-level interaction between individual- and neighborhood-level factors was also examined. We found a significant interaction between individual-level health insurance coverage and neighborhood health care providers' availability. Those who were uninsured and living in areas with limited health care provider availability (bottom 20%) were the most disadvantaged. This study adds to the growing literature on the effect of neighborhood-level factors on health care as sources of disparities. For health care policy, identifying individuals without health insurance coverage and living in a neighborhood with limited health care providers should be a priority to diminish disparities in access to care.
Asunto(s)
Asiático , Accesibilidad a los Servicios de Salud , Servicios Preventivos de Salud , Humanos , Pacientes no Asegurados , Estados Unidos , Características de la Residencia , Disparidades en Atención de SaludRESUMEN
Subsidized senior housing helps many socioeconomically disadvantaged older adults pursue independent living and aging in place. However, cognitive impairment or dementia poses a critical challenge to many residents' ability to live independently and safely. Focusing on Korean American dementia caregivers, a group known to be vulnerable to caregiving burden but understudied, we explored the safety of persons with dementia in senior housing from the perspectives of caregivers. Qualitative data from nine caregivers whose care recipients were current or former residents of subsidized senior housing in Los Angeles were analyzed by the constant comparative method. Major concerns emerged were: (1) fire risks, (2) wandering, (3) physical injury (e.g., self-harm, falls), and (4) potential neglect. Caregivers also mentioned errors in the self-administration of medications, potential financial exploitation, and interpersonal conflicts. These concerns provide implications for services and programs for the safety of persons with dementia who live in senior housing.
Asunto(s)
Asiático , Cuidadores , Trastornos del Conocimiento , Demencia , Hogares para Ancianos , Anciano , Humanos , Asiático/psicología , Asiático/estadística & datos numéricos , Cuidadores/psicología , Cuidadores/estadística & datos numéricos , Demencia/epidemiología , Demencia/psicología , Demencia/terapia , Hogares para Ancianos/economía , Hogares para Ancianos/normas , Hogares para Ancianos/estadística & datos numéricos , Los Angeles/epidemiología , Trastornos del Conocimiento/epidemiología , Trastornos del Conocimiento/psicología , Trastornos del Conocimiento/terapiaRESUMEN
Within the general population, caregivers of individuals with severe mental illness experience considerable mental health burdens. Less is known about these burdens among Asian Americans, who frequently serve as primary caregivers of family members in accordance with cultural values of familism and interdependence. Asian American caregivers experience severe stigma regarding mental health issues as well as other barriers to care, often resulting in decreased help-seeking behaviors and poorer mental health. Given a paucity of research, the authors systematically reviewed the literature on mental health outcomes among Asian American caregivers. This column offers policy and practice suggestions for supporting the mental health of Asian American families affected by severe mental illness.
Asunto(s)
Asiático , Trastornos Mentales , Humanos , Salud Mental , Cuidadores/psicología , Trastornos Mentales/psicología , FamiliaRESUMEN
Guided by the theories of social capital and stress-buffering, we examined how the association between low acculturation and poor mental health among older immigrants would be modified by social capital in ethnic communities (social cohesion, social engagement, perceived ethnic density, and the quality of social interaction). Using data from the Study of Older Korean Americans (N = 2,150, Mean age = 73.4), direct and interactive effect models were examined. Lower acculturation was associated with a greater level of psychological distress, and their link was modified by social cohesion (ß = .19, p < .01) and negative social interactions (ß = - .97, p < .01). Findings suggest that the mental health risk associated with low acculturation could be intensified when older immigrants perceive low sense of cohesion in their ethnic communities or have negative interactions with ethnic community members.
Asunto(s)
Aculturación , Emigrantes e Inmigrantes , Distrés Psicológico , Capital Social , Anciano , Humanos , Asiático/etnología , Asiático/psicología , Emigrantes e Inmigrantes/psicología , Salud Mental/etnología , Estados Unidos , Cohesión Social/etnologíaRESUMEN
The present study explored the role of loneliness in the association between social isolation and psychological distress, using a cross-sectional sample of older Korean immigrants in the U.S. Considering structural (unmarried and living alone) and relational (isolation from family and friends) social isolation, we hypothesized that (1) both types of social isolation would be associated with loneliness and psychological distress and (2) their effect on psychological distress would be mediated through loneliness. Data came from the Study of Older Korean Americans (SOKA), a multisite survey of Korean immigrants aged 60 and older (n = 2,150). The multivariate analyses demonstrated that older individuals with structural and relational isolation reported higher levels of loneliness and psychological distress. Loneliness was found to mediate the effect of both types of social isolation on psychological distress. The intervening role of loneliness suggests strategies to alleviate the mental health consequences of social isolation in older immigrants.
Asunto(s)
Emigrantes e Inmigrantes , Distrés Psicológico , Humanos , Estados Unidos , Persona de Mediana Edad , Anciano , Soledad/psicología , Estudios Transversales , Aislamiento Social/psicología , República de CoreaRESUMEN
OBJECTIVES: We identified types of family relationships of older Korean Americans and examined how the mental health benefit of friend networks might be conditioned by family type. METHODS: Data were from 2,070 participants in the Study of Older Korean Americans, a multistate survey of Korean immigrants aged 60 and older (Mage = 73.3, standard deviation [SD] = 8.01). To identify family types, latent profile analysis (LPA) was performed with marital status, living arrangement, family network, positive and negative interactions with family members, and family mistreatment. Linear regression models examined how mental distress was associated with friend networks and family types, as well as their interactions. RESULTS: LPA identified 5 family types: close-knit, intimate but distant, detached, connected but dysfunctional, and dysfunctional. Greater distress was associated with smaller friend networks and belonging to the detached, connected but dysfunctional, and dysfunctional family types in comparison to the close-knit type. The interaction model showed that people in the connected but dysfunctional and dysfunctional groups had a stronger association between friend networks and mental distress than the counterparts in the close-knit group. DISCUSSION: We not only confirmed the health-promoting role of friend networks and the value of a close-knit family but also found that the benefit of friend networks was pronounced when quality of the family relationship was impaired. Our findings called renewed attention to older immigrants' social convoys of family and friends, suggesting that the enhancement of friend networks could be particularly advantageous for older immigrants with dysfunctional family relationships.