Adaptation of the All Aspects of Health Literacy Scale (AAHLS) for Karen refugees: factor analysis.

Health literacy has been identified as a significant predictor of healthcare utilization among refugee and immigrant communities. Considering its potential impact on their health outcomes, accurately measuring levels of health literacy among limited English proficiency (LEP) populations is an important area of investigation. This study examined the psychometric properties of a modified version of the All Aspects of Health Literacy Scale (AAHLS), based on Nutbeam's model of health literacy, using an exploratory factor (EFA) and confirmatory factor (CFA) analysis among a sample of Karen refugees, an ethnic minority group from Burma. Results of the EFA confirmed a 3-factor model in our sample. CFA results indicated good model fits, demonstrating a promising use of the AAHLS in assessing health literacy among Karen refugees. The findings of this study support the validity of using this measure among this population and suggest some necessary adjustments to incorporate factors unique to the refugee experience that may affect the interpretation and application of items in the AAHLS. Further replication using other LEP samples is necessary to confirm the psychometric properties of the AAHLS and its ability to assess health literacy using Nutbeam's theoretical model of health literacy.

Social Determinants of Mental Health Among Karen Refugees from Burma.

Extant literature has documented a higher level of mental health issues among refugee populations compared with that of the general population. Mental health problems may significantly decrease refugees' quality of life and interfere with a successful transition to their country of resettlement. Using the social determinants of mental health framework, we examined factors affecting psychological distress among Karen refugees from Burma residing in a mid-size city in a northeastern state in the United States. A total of 201 participants completed face-to-face interviews conducted in the Karen language. Results showed that trauma and religious participation were positively associated and education and health status were negatively associated with psychological distress. The findings of this study reiterate the importance of trauma and health conditions to mental health and suggest potential points of interventions among the resettled Karen refugees.

"Mental Health Is for Crazy People": Perceptions and Barriers to Mental Health Service Use among Refugees from Burma.

Good mental health is essential to successful integration for refugee populations that resettle in the U.S. We explored perceptions of mental illnesses and barriers to mental health service use as well as solutions to current mental health problems from the perspective of refugees. The interviews with a convenience sampling of 11 community leaders (6 men and 5 women) from various Burmese ethnic communities revealed three major categories, including sources of mental illnesses (e.g. traumatic experiences and post-resettlement challenges), barriers to service use (e.g. lack of understanding about mental health, linguistic challenges, cultural stigma, alternative treatments, and unresponsive system), and proposed community solutions (e.g. community education, culturally-competent providers, and beyond mental health treatment). The findings suggest that the ethnic community can be a source of potential solutions to mitigate barriers to mental health service use.

Simple contents and good readability: Improving health literacy for LEP populations.

Accessing and receiving quality healthcare in an unfamiliar health system is a significant challenge for many new immigrants and refugees. This study aims to provide a three-phase model to develop a web-based health information website that helps populations with limited English proficiency (LEP) increase health literacy and improve healthcare service access. METHOD: First, we conducted a needs assessment from community leaders and service providers. Second, we developed contents from credible sources and tested each item using multiple readability tests. Last, we revised each item to lower the readability and retest its readability. RESULTS: The average reading level for the original 99 topics was assessed at 10.84 (SD= 3.26). After revisions, we were able to lower the readability to 8.56 (SD= 2.96), which was around two grade levels lower, on average. CONCLUSION: the main purpose for building an English based health information website was to assist the population with LEP. By using simple English with lower readability, it will ease the translation process. This study demonstrates a process to develop suitable contents for populations in need. In the future, incorporating visual aid and other multimedia will be beneficial in user engagement and knowledge retention.

"Gambling Can't Be Positive, Can it?": Gambling Beliefs and Behaviors Among Older Korean Immigrants.

After migrating to the United States, older Korean immigrants may increase their gambling participation and be at higher risk for problem gambling. However, not much is known about their experiences and beliefs on gambling. The purpose of the present study was to explore gambling behaviors and shared beliefs about gambling among older Korean immigrants residing in New York City. A total of 20 semi-structured in-depth interviews (10 men and 10 women) were conducted in Korean. Interviews were transcribed verbatim and analyzed using a thematic analysis approach. The findings revealed three major categories among older Korean immigrants. The first category, cultural beliefs, has three subcategories (i.e., gambling is unethical, fear of addiction, and losing everything) and refers to negative beliefs about gambling. The second category, adaptation, refers to positive attitudes they acquired as they adjusted to the new gambling environment (i.e., harmless leisure, coping strategies, and excitement in life). Last, they revealed ambivalence about gambling (i.e., changes in gambling environment, 'my gambling' is different, and gambling in secrecy). Overall, older Korean immigrants have retained their cultural beliefs about gambling, even as they have embraced the legalized gambling environment and changed social norms of the U.S. However, they have trouble reconciling the differences between their beliefs, behaviors, values, and newly acquired norms. Findings point to a need for healthy and affordable leisure pursuits, and for culturally appropriate intervention programs to help problem gamblers.

Challenges in health-care service use among Burmese refugees: A grounded theory approach.

The timely use of health-care services is essential to achieve the best health outcomes. We explore barriers to health-care access among refugees from Burma through interviews with key community informants who serve their community as interpreters, health-care professionals, paraprofessionals, and/or representatives. The interviews with a convenience sampling of 11 leaders from Burmese and Karen ethnic communities revealed three stages of health-care use (i.e., before, during, and after doctor's appointments), in which their community members encounter difficulties in accessing health-care services. Using grounded theory analysis approach, specific difficulties and cultural considerations for each stage were emerged. This study suggests that training programs for health-care providers on refugee populations' needs, cultural expectations, attitudes, and health behaviors may ease the process for refugees during each of these three stages. Interpreters as cultural brokers have an important role in facilitating cross-cultural communications not only before and during the appointment but also after doctor's visits, such as in the pharmacy and labs.

"It's Not Officially Gambling": Gambling Perceptions and Behaviors Among Older Chinese Immigrants.

Personal and media accounts have suggested that Chinese communities engage in high rates of gambling, which is reflected in the fact that casinos are specifically targeting Chinese communities through advertisements and promotions. However, not much is actually known about older Chinese immigrants' experiences and perceptions of gambling in the U.S. This study seeks to explore how older Chinese immigrants define and describe gambling and their own gambling behaviors. Thematic analysis was used to identify major themes across in-depth interviews of 25 older Chinese immigrants living in New York City. Our analysis identified three avenues in defining gambling. First, they differentiated "gambling" from "playing." Second, they equated "gambling" with "problem gambling." Last, they associated "gambling" with major losses. In describing their own motivations for gambling and playing, participants indicated that there were many positive reasons for playing. The analyses revealed four themes under which participants described their motivations: gambling as a coping strategy; gambling as a form of socialization; gambling to improve health; and gambling to prove their luck or skill. Identifying older Chinese immigrants' perceptions and motivations around gambling can better equip us to address their needs.

Trauma, Discrimination, and Psychological Distress Across Vietnamese Refugees and Immigrants: A Life Course Perspective.

Vietnamese Americans are a heterogeneous group with varied migration histories. The life course perspective (LCP) suggests that different migration histories (immigrant vs. refugee) may affect their psychological health. Using Vietnamese refugee (n = 291) and immigrant (n = 211) subsamples from the National Latino and Asian American Study, selected LCP factors relevant to foreign-born Vietnamese were examined for their associations with psychological distress. Two separate regressions were conducted to examine differential factors across the subgroups. Results showed that sex, age at immigration, and pre- and post-migration traumas were significant factors for refugees. Among immigrants, only racial discrimination was significant factor. The results suggest that applying LCP among Vietnamese Americans helps to discern factors associated with their psychological distress outcomes depending on their initial immigration status. The results also indicate that healthcare professionals should consider the migration background of foreign-born Vietnamese in screening for potential psychological issues, particularly around their trauma history and discriminatory experiences.

The Effects of Religious Participation and Familial Assistance on Mental Health among Older Chinese and Korean Immigrants: Multiple Mediator Analyses.

Older Asian immigrants are one of the fastest growing segments of the U.S. population and a growing number of them reside in non-traditional destination cities. However, there is a paucity of research on older Asian immigrants living in these non-traditional destination cities, and how this residential choice impacts their stress and mental health. In the current study, we examined how stressors and social support contribute to the overall mental health of older Asian immigrants who lack access to culturally responsive formal social support services. Using a convenience sample of older Chinese (n = 120) and Korean (n = 118) immigrants living in Arizona, we conducted multiple mediator analyses, focusing specifically on how ethnicity would differentially influence mediating effects of religious participation and familial assistance in the relationships between physical/acculturative stressors and mental health outcomes. The results showed that among older Chinese immigrants, religious participation significantly mediated the relationships between both physical/acculturative stressors and mental health, while there was no significant mediation effect detected among older Korean immigrants. Although Asian Americans are often perceived as a monolithic homogeneous group, the multiple mediator models suggest significant differences in the use of cultural/information resources in coping with life stressors and their impact on mental health outcomes between the older Chinese and Korean immigrants in our study. The study findings suggest a need for developing and strengthening formal social services in non-traditional destination cities that are culturally and linguistically responsive to those older Asian immigrants.

Strengthening effective preventive services for refugee populations: toward communities of solution.

Refugee populations have unequal access to primary care and may not receive appropriate health screening or preventive service recommendations. They encounter numerous health care disadvantages as a consequence of low-income status, race and ethnicity, lower educational achievement, varying degrees of health literacy, and limited English proficiency. Refugees may not initially embrace the concept of preventive care, as these services may have been unavailable in their countries of origin, or may not be congruent with their beliefs on health care. Effective interventions in primary care include the appropriate use of culturally and linguistically trained interpreters for health care visits and use of evidence-based guidelines. Effective approaches for the delivery of preventive health and wellness services require community engagement and collaborations between public health and primary care. In order to provide optimal preventive and longitudinal screening services for refugees, policies and practice should be guided by unimpeded access to robust primary care systems. These systems should implement evidence-based guidelines, comprehensive health coverage, and evaluation of process and preventive care outcomes.

Recognizing the Two Faces of Gambling: The Lived Experiences of Korean Women Gamblers.

PURPOSE: The aim of this study was to explore the lived experiences of women problem gamblers, focusing on the meaning of gambling to them, how and why these women continue to gamble or stop gambling, and their needs and concerns. In order to effectively help women problem gamblers, practical in-depth knowledge is necessary to develop intervention programs for prevention, treatment, and recovery among women problem gamblers. METHODS: The hermeneutic phenomenology approach was used to guide in-depth interviews and team interpretation of data. Sixteen women gamblers who chose to live in the casino area were recruited through snowball sampling with help from a counseling center. Participants were individually interviewed from February to April 2013 and asked to tell their stories of gambling. Transcribed interviews provided data for interpretive analysis. RESULTS: In the study analysis one constitutive pattern was identified: moving beyond addiction by recognizing the two faces of gambling in their life. Four related themes emerged in the analysis-gambling as alluring; gambling as 'ugly'; living in contradictions; and moving beyond. CONCLUSION: Loneliness and isolation play a critical role in gambling experiences of women gamblers in Korea. In other words, they are motivated to gamble in order to escape from loneliness, to stop gambling for fear of being lonely as they get older, and to stay in the casnio area so as not to be alone. The need for acceptance is one fo the important factors that should be considered in developing intervention program for women.

Differential Patterns of Healthcare Service Use Among Chinese and Korean Immigrant Elders.

Previous studies of healthcare service use among Asian immigrant elders have been conducted in major metropolitan areas with established ethnic enclaves. The factors that affect levels of utilization by Asian immigrant elders who live in places where systematic support from an ethnic community is not readily available are unknown. This study employed the Andersen-Newman healthcare service utilization model to examine unique correlates of healthcare service use among Chinese and Korean immigrant elders. Between 2005 and 2007, we used a snowball sampling method to collect data from Chinese (n = 116) and Korean (n = 101) immigrant elders living in Arizona. We then performed two negative binomial regressions based on ethnic background to identify factors associated with the number of annual physician visits. The results indicated that the number of medical conditions they experienced was positively associated with an increased likelihood of healthcare service utilization for both subgroups. However, the results indicated that each ethnic group had distinctive predisposing (sex and length of US stay for Chinese; marital status for Korean), enabling (English proficiency and cultural gap; insurance status), and need factors (depressive symptoms; self-reported health status) for predicting healthcare service utilization. Asian immigrant elders in this study experienced unique barriers and facilitators based on their ethnic backgrounds. Communicating with these two different groups in their native languages and better understanding their cultural backgrounds are imperative to understanding the factors related to their healthcare service utilization. Thus, rather than viewing Asians as a homogeneous population, the differences found in heterogeneous ethnic groups, such as language and cultural variations, should be taken into account when planning and implementing approaches to intervention.

Depression among Korean immigrant elders living in Canada and the United States: a comparative study.

Korean immigrant elders in North America experience a high level of depression. This study explored the correlates of depression among a sample of 245 Korean immigrant elders living in metropolitan cities in Canada (n = 128) and a southwestern state in the United States (n = 117), using a stress-coping framework. Results revealed discrepancies between the 2 subgroups. Years since immigration and number of health concerns were positively associated, and English proficiency was negatively associated with depressive symptoms among Korean immigrant elders in the United States; only health status was significant among Korean immigrant elders in Canada. Implications of the study are presented.

Korean immigrant women's lived experience of childbirth in the United States.

OBJECTIVE: To understand Korean immigrant women's common experiences and practices of utilizing health care services in the United States during childbirth. DESIGN: A qualitative interpretive phenomenological research design. SETTING: Recruitment was conducted through advertisement on the MissyUSA.com website, which is the largest online community for married Korean women who live in North America. PARTICIPANTS: A purposive sample of 15 Korean immigrant women who experienced childbirth in the United States within the past 5 years was recruited. METHODS: Data were collected using semistructured telephone interviews and were analyzed using the Heideggerian hermeneutical methodology. RESULTS: During childbirth in the United States, participants faced multifaceted barriers in unfamiliar sociocultural contexts yet maintained their own cultural heritages. They navigated the unfamiliar health care system and developed their own strategies to overcome barriers to health care access. Korean immigrant women actively sought health information on the Internet and through social networking during childbirth. CONCLUSIONS: Korean immigrant women selectively accepted new cultural beliefs with some modifications from their own cultural contexts and developed their own distinct birth cultures. Understanding a particular culture and respecting women's traditions, beliefs, and practices about their childbirth could help nurses to provide culturally sensitive care.

Emotional support, instrumental support, and gambling participation among Filipino Americans.

Using representative survey data of Filipino Americans in Honolulu and San Francisco (SF) (N = 2,259), we examined the roles of emotional support and instrumental support on gambling participation. With considerable difference in gambling environments between two regions, we conducted two sets of hierarchical regression analyses for Honolulu sample, which has restricted gambling laws, and SF sample, which has legal gambling environment, and compared the effects of two types of social support on gambling participation. The results indicated that emotional support was positively and instrumental support was negatively associated with gambling participation among Filipino Americans in Honolulu. However, neither type of social support was significantly associated with gambling participation among Filipino Americans living in SF. This study highlights the differing roles and effects of instrumental and emotional support on gambling where gambling is restricted. It also suggests that gambling behaviors of Filipino Americans are subject to situation- and environment-specific factors.

Predictors of gambling behaviors in Filipino Americans living in Honolulu or San Francisco.

This study compared the prevalence and predictors of gambling behaviors between Filipino Americans who live in San Francisco (S.F.) or Honolulu. Data from the 1998-1999 Filipino American Community Epidemiological Survey were used to answer two research questions: (1) What are the prevalence and types of gambling behaviors among Filipino Americans and (2) What are the protective/risk factors of heavy gambling for Filipino Americans in S.F. and Honolulu? Overall, S.F. Filipino Americans had a higher level of participation in gambling, and the odds of gambling increased among older age groups, males, those who were US-born, and those with more health problems. Multinomial logistic regression analyses revealed that factors associated with infrequent and regular gambling participation were different between the S.F. group (older, male, higher education) and Honolulu group (male, US-born, more health concerns). Differential gambling environments, i.e., wide open gambling in S.F. and the restrictive gambling in Honolulu, may contribute to gambling participation and predictors of risk gambling Filipino Americans living in Honolulu and S.F. Policy makers and health professionals need to be aware of these differences to serve this population more effectively.

The social determinants of depression in elderly Korean immigrants in Canada: does acculturation matter?

Depression in old age significantly decreases the quality of life and may lead to serious consequences, such as suicide. Existing literature indicates that elderly Korean immigrants may experience higher levels of depression than other racial ethnic group elders. The purpose of this exploratory study was to investigate factors that influence depression among older Korean immigrants in Toronto. A total of 148 participants, ages 60 years or older (mean age = 74.01, SD = 8.24), completed face-to-face interviews in Korean language. Hierarchical regression analyses were conducted by adding variables in three steps: (1) demographic variables; (2) acculturation variables (years of immigration and English proficiency); and (3) social determinants (social integration variables, physical health, and financial satisfaction). Results showed that acculturation factors were not associated with depression. Instead, social determinants variables, including lower physical health status and lower financial status, living alone, and lower level of social activity, predicted higher level of depressive symptoms, along with lower education. The final regression model explained about 37% of variance of depression in the sample. These results suggest that social determinants, not acculturation, are important factors explaining the levels of depression in Korean immigrant elders living in a metropolitan city in Canada. Implications for practice are discussed.

Risk and protective factors of alcohol use disorders among Filipino Americans: location of residence matters.

BACKGROUND: Despite the growing number of Asian Americans (AA) in the United States, research on alcohol abuse in this population is sparse. Although AA have few alcohol use disorders (AUD) as an aggregate group, within-group variations in AUD need to be explored among specific ethnic groups in this population. OBJECTIVES: This study compared correlates of 12-month prevalence of AUD between Filipino Americans who currently drink alcohol and live in San Francisco (SF) or Honolulu. METHODS: Data from the 1998-1999 Filipino American Community Epidemiological Survey (N = 537) were used to test two hypotheses: 1) current drinkers in SF and Honolulu will differ in the characteristics and prevalence of AUD and 2) current drinkers in SF and Honolulu do not share the same protective and risk factors of AUD. RESULTS: Current drinkers from the two regions substantially differed in age, years of education, age at first drink, religiosity, ethnic identity, psychological distress, the nativity status, as well as the prevalence of AUD. Logistic regression models revealed that AUD risk factors were different for SF current drinkers (higher psychological distress, U.S.-born, and lower religiosity) compared to Honolulu drinkers (more years of education and lower emotional support). CONCLUSION: Filipino American drinkers living in SF and Honolulu have different risk and protective factors for AUD. Health professionals need to be aware of this difference when screening for factors associated with AUD among Filipino Americans. SCIENTIFIC SIGNIFICANCE: The current study revealed the importance of socioenvironmental context (location of residence) in predicting AUD among an Asian ethnic group.

Barriers to healthcare among Asian Americans.

The myth of the well-adjusted Asian American resulted from sample-biased research studies that concluded that Asian Americans are physically healthier and financially better off than Caucasians. The myth has been perpetuated by researchers who have often categorized Asian Americans as a single, undifferentiated group rather than as distinct ethnic groups. Consequently, data analysis techniques do not reveal distinctions that may exist had the researchers controlled for ethnic group variation. The authors discussed four major barriers-language and culture, health literacy, health insurance, and immigrant status-to healthcare that may influence within-group disparities among Asian Americans that may go unreported. The authors argue that healthcare policy makers and researchers should consider Asian Americans as members of discrete ethnic groups with unique healthcare needs. Recommendations for health policies and future research are provided.

The evolution of drinking motivations among Korean women with alcohol dependence.

Our purpose in conducting this study was to explore increases in alcohol problems among women in South Korea. Qualitative data were collected from 10 women in treatment for alcohol dependence using in-depth interviews. The grounded theory analysis revealed three phases of drinking behavior that were driven by certain motivations: (1) positive experiences, (2) coping with negative emotions, and (3) needing alcohol to function. The findings suggest that the increased occurrence of alcohol dependence among Korean women may be associated with shifting expectations about women's alcohol use and conflicts between their traditional and modern gender roles in the rapidly changing society.