International Journal of Social Science Research
Healthcare Access and Utilization among Korean Americans: The Mediating Role of English Use and Proficiency
Abstract
The literature suggests that Korean Americans underutilize health services. Cultural factors and language barriers appear to influence this pattern of low utilization but studies on the relationships among length of stay in the US, English use and proficiency, and utilization of health services among Korean Americans have yielded inconsistent results. This study examines whether English language use and proficiency plays a mediating role in the relationships between length of stay in the US and health insurance coverage, access to and use of care. Structural equation modeling was used for mediation analysis with multiple dependent variables among Korean Americans (N= 555) using baseline data from a large trial designed to increase Hepatitis B testing. The results show 36% of the total effect of proportion of lifetime in the US on having health insurance was significantly mediated by English use and proficiency (indirect effect =0.166, SE= 0.07, p<.05; direct effect=0.296, SE= 0.13, p<.05). Proportion of lifetime in the US was not associated with usual source of care and health service utilization. Instead, health care utilization was primarily driven by having health insurance and a usual source of care, further underscoring the importance of these factors. A focus on increasing English use and proficiency and insurance coverage among older, female, less educated Korean Americans has the potential to mitigate health disparities associated with reduced access to health services in this population.
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Abraido-Lanza, A. F., Armbrister, A. N., Florez, K. R., & Aguirre, A. N. (2006). Toward a theory-driven model of acculturation in public health research. American Journal of Public Health, 96(8), 1342-1346. http://dx.doi.org/10.2105/ajph.2005.064980
Akaike, H. (1987). Factor analysis and AIC. Psychometrika, 52(3), 317-332. http://dx.doi.org/10.1007/BF02294359
Akresh, I. (2009). Health service utilization among immigrants to the United States. Population Research and Policy Review, 28(6), 795-815. http://dx.doi.org/10.1007/s11113-009-9129-6
Andersen, R., & Davidson, P. (2007). Improving access to care in America: Individual and contextual indicators. In R. Andersen, T. H. Rice & G. F. Kominski (Eds.), Changing the U.S. health care system : Key issues in health services policy and management (3rd ed., pp. 4-10). San Francisco: Jossey-Bass.
Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1-10. http://dx.doi.org/10.2307/2137284
Bastani, R., Glenn, B. A., Maxwell, A. E., Jo, A. M., Herrmann, A. K., Crespi, C. M., ... Taylor, V. M. (2015). Cluster-randomized trial to increase Hepatitis B testing among Koreans in Los Angeles. Cancer Epidemiology, Biomarkers & Prevention : A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology, 24(9), 1341-9. http://dx.doi.org/10.1158/1055-9965.epi-14-1396
Bowen, N. K. (2012). In Guo S. (Ed.), Structural equation modeling. Oxford ;New York: Oxford University Press. Retrieved from http://search.lib.unc.edu?R=UNCb7025569
Breen, R., Karlson, K. B., & Holm, A. (2013). Total, direct, and indirect effects in logit and probit models. Sociological Methods & Research. http://dx.doi.org/10.1177/0049124113494572
Chang, E., Chan, K. S., & Han, H. R. (2015). Effect of acculturation on variations in having a usual source of care among Asian Americans and non-Hispanic whites in California. American Journal of Public Health, 105(2), 398-407. http://dx.doi.org/10.2105/AJPH.2014.301950
Colby, S. L., & Ortman, J. M. (2015). Projections of the size and composition of the US population: 2014 to 2060. Retrived from Https://www.Census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.Pdf
Derose, K. P., Escarce, J. J., & Lurie, N. (2007). Immigrants and health care: Sources of vulnerability. Health Affairs (Project Hope), 26(5), 1258-1268. http://dx.doi.org/10.1377/hlthaff.26.5.1258
Flaskerud, J. H., & Kim, S. (1999). Health problems of Asian and Latino immigrants. The Nursing Clinics of North America, 34(2), 359-380.
Frisbie, W. P., Cho, Y., & Hummer, R. A. (2001). Immigration and the health of Asian and Pacific Islander adults in the United States. American Journal of Epidemiology, 153(4), 372-380. http://dx.doi.org/10.1093/aje/153.4.372
Hoyle, R. H., & Kenny, D. A. (1999). Sample size, reliability, and tests of statistical mediation. Statistical Strategies for Small Sample Research, 1, 195-222.
James, L. R., & Brett, J. M. (1984). Mediators, moderators, and tests for mediation. Journal of Applied Psychology, 69(2), 307-321. http://dx.doi.org/10.1037//0021-9010.69.2.307
Kang, S. Y., Howard, D., Kim, J., Payne, J. S., Wilton, L., Kim, W., & Maramba, D. (2010). English language proficiency and lifetime mental health service utilization in a national representative sample of Asian Americans in the USA. Journal of Public Health (Oxford, England), 32(3), 431-439. http://dx.doi.org/10.1093/pubmed/fdq010
Kim, J., & Chan, M. M. (2004). Factors influencing preferences for alternative medicine by Korean Americans. The American Journal of Chinese Medicine, 32(2), 321-329. http://dx.doi.org/10.1142/s0192415x04001977
Kim, Y. Y. (1978). A communication approach to the acculturation process: A study of Korean immigrants in Chicago. International Journal of Intercultural Relations, 2(2), 197-224. http://dx.doi.org/10.1016/0147-1767(78)90006-8
le Cessie, S., Debeij, J., Rosendaal, F. R., Cannegieter, S. C., & Vandenbroucke, J. P. (2012). Quantification of bias in direct effects estimates due to different types of measurement error in the mediator. Epidemiology (Cambridge, Mass.), 23(4), 551-560. http://dx.doi.org/10.1097/ede.0b013e318254f5de
Lee, H. Y., Ju, E., Vang, P. D., & Lundquist, M. (2010). Breast and cervical cancer screening disparity among Asian American women: Does race/ethnicity matter [corrected]? Journal of Women's Health (2002), 19(10), 1877-1884. http://dx.doi.org/10.1089/jwh.2009.1783
Lee, S., Choi, S., & Jung, M. J. (2014). Ethnic variation in access to health care of Asian Americans who are not U.S. citizens: Chinese, Korean, and Vietnamese ethnic groups. Journal of Health Care for the Poor and Underserved, 25(2), 577-590. http://dx.doi.org/10.1353/hpu.2014.0104
Lopez-Class, M., Castro, F. G., & Ramirez, A. G. (2011). Conceptions of acculturation: A review and statement of critical issues. Social Science & Medicine (1982), 72(9), 1555-1562. http://dx.doi.org/10.1016/j.socscimed.2011.03.011
MacKinnon, D. P. (1994). Analysis of mediating variables in prevention and intervention research. NIDA Research Monograph, 139, 127-127. http://dx.doi.org/10.1037/e495892006-009
Marin, G., Sabogal, F., Marin, B. V., Otero-Sabogal, R., & Perez-Stable, E. J. (1987). Development of a short acculturation scale for Hispanics. Hispanic Journal of Behavioral Sciences, 9(2), 183-205. http://dx.doi.org/10.1177/07399863870092005
Maxwell, A. E., & Crespi, C. M. (2009). Trends in colorectal cancer screening utilization among ethnic groups in California: Are we closing the gap? Cancer Epidemiology, Biomarkers & Prevention : A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology, 18(3), 752-759. http://dx.doi.org/10.1158/1055-9965.EPI-08-0608
Maxwell, A. E., Crespi, C. M., Antonio, C. M., & Lu, P. (2010). Explaining disparities in colorectal cancer screening among five Asian ethnic groups: A population-based study in California. BMC Cancer, 10, 214-2407-10-214. http://dx.doi.org/10.1186/1471-2407-10-214
Muthen, B., & Asparouhov, T. (2015). Causal effects in mediation modeling: An introduction with applications to latent variables. Structural Equation Modeling: A Multidisciplinary Journal, 22(1), 12-23. http://dx.doi.org/10.1080/10705511.2014.935843
Muthen, L. K., & Muthen, B. O. (2010). Mplus user’s guide (6th ed.). Los Angeles, CA: Muthen & Muthen.
Nam, Y. (2008). Welfare reform and older immigrants' health insurance coverage. American Journal of Public Health, 98(11), 2029-2034. http://dx.doi.org/10.2105/AJPH.2007.120675
Oh, K. M., & Jacobsen, K. H. (2014). Colorectal cancer screening among Korean Americans: A systematic review. Journal of Community Health, 39(2), 193-200. http://dx.doi.org/10.1007/s10900-013-9758-x
Park, S. Y., Cho, S., Park, Y., Bernstein, K. S., & Shin, J. K. (2013). Factors associated with mental health service utilization among Korean American immigrants. Community Mental Health Journal, 49(6), 765-773. http://dx.doi.org/10.1007/s10597-013-9604-8
Pourat, N., Kagawa-Singer, M., Breen, N., & Sripipatana, A. (2010). Access versus acculturation: Identifying modifiable factors to promote cancer screening among Asian American women. Medical Care, 48(12), 1088-1096. http://dx.doi.org/10.1097/MLR.0b013e3181f53542
Ryu, H., Young, W. B., & Park, C. (2001). Korean American health insurance and health services utilization. Research in Nursing & Health, 24(6), 494-505. http://dx.doi.org/10.1002/nur.10009
Satorra, A. (2000). Scaled and adjusted restricted tests in multi-sample analysis of moment structures. In R. D. H. Heijmans, D. S. G. Pollock & A. Satorra (Eds.), Innovations in multivariate statistical analysis. A festschrift for heinz neudecker (pp. 233-247). London: Kluwer Academic Publishers.
Schwarz, G. (1978). Estimating the dimension of a model. The Annals of Statistics, 6(2), 461-464. http://dx.doi.org/10.1214/aos/1176344136
Sclove, S. (1987). Application of model-selection criteria to some problems in multivariate analysis. Psychometrika, 52(3), 333-343. http://dx.doi.org/10.1007/BF02294360
Scommegna, P. (2013). Today’s research on aging: Elderly immigrants in the United States. (No. 29). Population Reference Bureau.
Shin, H., Song, H., Kim, J., & Probst, J. C. (2005). Insurance, acculturation, and health service utilization among Korean-Americans. Journal of Immigrant Health, 7(2), 65-74. http://dx.doi.org/10.1007/s10903-005-2638-4
Sohn, L., & Harada, N. D. (2004). Time since immigration and health services utilization of Korean-American older adults living in Los Angeles County. Journal of the American Geriatrics Society, 52(11), 1946-1950. http://dx.doi.org/10.1111/j.1532-5415.2004.52524.x
Stein, J. A., Andersen, R. M., Robertson, M., & Gelberg, L. (2012). Impact of Hepatitis B and C infection on health services utilization in homeless adults: A test of the Gelberg-Andersen Behavioral Model for vulnerable populations. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 31(1), 20-30. http://dx.doi.org/10.1037/a0023643
VanderWeele, T. J., Valeri, L., & Ogburn, E. L. (2012). The role of measurement error and misclassification in mediation analysis: Mediation and measurement error. Epidemiology (Cambridge, Mass), 23(4), 561-564. http://dx.doi.org/10.1097/EDE.0b013e318258f5e4
Vargas Bustamante, A., Chen, J., Fang, H., Rizzo, J. A., & Ortega, A. N. (2014). Identifying health insurance predictors and the main reported reasons for being uninsured among US immigrants by legal authorization status. The International Journal of Health Planning and Management, 29(1), e83-96. http://dx.doi.org/10.1002/hpm.2214
DOI: https://doi.org/10.5296/ijssr.v4i1.8678
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