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Impact of Language on Asian American Health

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Submitted By amold92
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Running Head: Impact of Language on Asian American Health

Impact of English Language Proficiency (ELP) on Health and Health Care
Among Elderly Asian Americans

Amoldeep Kaur
Written Assignment #2
Epidemiology/Public Health 240
Winter 2013

The elderly population is the fastest growing population in the United States, and the number of immigrants that fall within this group has nearly doubled (Ninez, Hsys, & Cunnigham (2005). Foreign-born elderly account for 11% of the elderly population and this is expected to quadruple in size and reach 16 million by 2050 (Terrazas & Batalova, 2009). Currently most foreign born elders belong to Europe, but this is predicted to change in the upcoming years. Asians are among one of the fastest growing elderly population in the United States (Belozersky, 2005). Majority of Asian Americans are foreign born and report speaking a language other than English (Searight, 2009). Multiple languages and dialects spoken by the subgroups within the Asian American population bring more linguistic diversity and disparities to the United States.
Furthermore, fastest growing minority in the United States has been stereotyped and inherited the label “model minority”. This label neglects the problems faced by the poorer and less successful member of this group, including the elderly, “they are hobbled by less blatant but more pervasive barrier of language and culture” (Dugger, 1992). Elderly immigrants find it more difficult to thrive in a new country. In addition to the stress of immigration, English Language Proficiency poses a major issue for this group. English proficiency has been an important factor in explaining disparities in health and health care access among older adults (Gentry, 2010). Limited English skills make it difficult to communicate health issues and concerns. Asian Immigrants that speak little or no English are denied equal access (Kim, Allen, & Worley, 2011)
Relevance to Public Health/Social Work
This study reflects the relevance of social work practice because it supports the primary goal of social work, help individuals in need and address social problems (NASW). Profession of social work already has been serving the historically labeled underserved and vulnerable population, elderly immigranqts. Furthermore, Asian American population is worth studying because it is the fastest growing minority population. Hence chances are very high that future social workers’ will encounter clients of this group.
Furthermore, social work profession’s commitment to human rights and social justice makes this topic worth studying. Social workers often work to empower the most vulnerable in ensuring access to services. Immigrants have fewer resources and higher needs, making this population very vulnerable and in need of services. Moreover, this study will add to the existing cultural knowledge of Asian American Immigrants. Language being the number one problem faced by immigrants, addressing the current and future language needs and training in cultural competence is essential to reach out to this increasing vulnerable population, and improve health of this vulnerable community.
Literature Review
Background of Elderly Asian Americans
Current statistics show that there are over 35 million adults over age 65 in the United States, this number is expected to reach nearly 70 million by 2030 (Sue & Sue, 2003). Foreign-born elderly account for 11% of the U.S. population. Among this group of elders, Asian elders represent one of the fastest growing groups in the United States (US census, 2010). Overall Asian American population, which currently accounts for 17.3 million of U.S. residents, is expected to more than triple in the next 50 years. Latest immigration trend shows growing numbers of Indians, Bangladeshis, Pakistanis and other South Asians among the Asian American population (Diwan & Jonnalagadda, 2001). This growth highlights the need for policy makers to understand the increase in diversity and their needs. This elderly immigrant group is recognized as vulnerable and underserved. In addition to stressors of acculturation, socio-economic and immigration status, Limited English proficiency (LEP) is another important contributor to immigrant vulnerability (Ponce, Hays & Cunningham, 2005).
Emerging research suggest that LEP is a major barrier to health related services and has been strongly related to health outcomes. Studies show immigrants with LEP have fewer physician visits, and receive less preventative care (Kim). In addition, this California-based study shows that individuals with LEP experienced health complications that arose from not being able to understand instructions or medical situations. High percentages of LEP individuals reported not being able to understand their doctor, compared to EP population. Ineffective patient-doctor communication creates a higher amount of vulnerability to serious health issues and health disparities. California Health Interview Survey (CHIS), reports LEP as a barrier to health communication and access to services.
HSBC Theories and Asian Immigrants
Cultural change within the Asian Immigrant group can be understood in terms of four processes described by Hutchison (2008). 1). Assimilation: Process of cultural change where the unique cultural values are exchanged for invisible blend into the dominant culture. Elderly immigrant parents often complain about Assimilation process being adapted by their children. In a study done by Vang & Lee (2010, elderly Asian parents in nursing homes blamed assimilation for their children not caring for them at home.
2). Accommodation: This process of cultural change can be described as the process of selective or partial change. Hutchison (2008) explains this process as using an example of immigrant group who have adapted the westernized view points but still eat ethnic food associated with their culture.
3). Acculturation: Mutual sharing of culture, this process of cultural change is where group from different backgrounds and cultures interact. Acculturation posses challenges for the elderly immigrants. Language barriers are reported as the key barrier for elderly immigrants to acculturate. In addition to the langue barriers, unfamiliarity with the way of life in the U.S., majority of the immigrants live with their family members to avoid their unfamiliar surroundings. Inability to acculturate increases the chances of isolation and marginalization by this population (Kreps & Sparks, 2009).
Moreover, the EP has been one of the key components of acculturation. Acculturation into the U.S. society is shown to improve socioeconomic status and “improve healthcare navigational skills” (Ponce N., Hays, R. & William, C. (2005). In addition to the positive benefits of acculturation, studies show that it leads to stressors; stressors that leave individuals feeling more marginalized and alienated, results in negative health status.
4).Bicultural socialization process refers to when members of a minority cultured adapt both their own culture and the dominant. This process can be referred to celebrities or athletes from other countries who successfully adapt with the western society, as well as their own culture.
Utilization of preventative services and Language
There are many health risks among the Asian American community. This group is on higher risk for cancer, cardiovascular, and diabetes conditions (Gee & Ponce, 2010). In addition, Asians carry higher risk of high blood pressure, high cholesterol, cigarette smoking, and obesity (Bates, Hill, & Barrett-Conner, 1989). Overall 61% were at moderate to high risk in at least one category. Some of these health risks are results of low rates of preventative care being utilized by Asian American elders. Research shows that Cancer is a tremendous burden on Asian American Health, and Asians Americans are the only group that reports cancer as the leading cause of death (Lee & Vang, 2010). Lee & Vang (2010), report that cancer rates of Asian Americans are twice that of Non-Hispanic whites. Cancer screening has been linked to this issue. Results in a study by Lee & Vang show language capability, cancer literacy, and Illiteracy in prevention to be among the barriers to cancer screening. New immigrant groups from Asia, have low literacy level, and limited English speaking skills, showed to have a higher risk of cancer and very low rates of cancer screening. Language barrier are also related to cancer literacy. Lack of cancer knowledge is a barrier to cancer screening and is associated with cancer screening behavior.
Studies shows that population with LEP experiences higher levels of psychological stress (Weisman & Feldman, 2005). Language shows to be a major barrier to accessing mental health services, and it overshadows ethnicity and health insurance status which was shown as the major barrier in previous studies. Furthermore, arrival of higher number of refugees into the United States has increased the demand of “interpreter-mediated” mental health services. States such as California is experiencing shortage of bilingual mental health providers to serve the high concentration of Southeast Asian refugee, very high number experiencing post traumatic stress symptoms (Weisman & Feldman, 2005). Serving this population is raising “clinical, ethical, and diagnosing dilemmas” for clinicians serving them. Language surrounding mental illnesses need to revised to reach out to the diverse linguistic needs, Urdu which is spoken by Pakistani and Afghanistan immigrants or refugees, “anxiety” and “depression” do not have direct English equivalents’” (Weisman, 2005).
Culture as a Barrier to Prevention
Research shows that cultural beliefs and attitudes are also a barrier in prevention. Among this group, screening is viewed as unnecessary in absence of symptoms. Furthermore, finding from this study indicate negative correlation between race/ethnicity of healthcare provider and cancer screening (Lee & Vang, 2010). It is suggested that this may be due to lower likelihood of physician recommending screening to their patients. Perhaps due to oversee training that may not have advocated for prevention. Additionally, Asian physicians may not recommend screening such as pap smears or breast examination in attempt to respect modesty of Asian women. Given that recommendation of the physician is the main reason why most women go through screening, culturally sensitive approach to cancer prevention is recommended since studies show low rates of screening and high rates of cancer rates and mortality among this group ( Lee & Vang, 2010).
Modesty has been recognized as a major barrier to cancer screening among traditional Asian American females. Traditional Asian Americans women, have a strong sense of modesty, which has prevented them from participating in screening that may cause embarrassment or shame (Lee & Vang, 2010). Asian women report elevated levels of anxiety when being screened by male providers for breast and cervical cancer. This may be the reason for low level of breast and cervical cancer screening among Asian American women.
Language Services and Health
There are very few interpreters trained to serve a specialized area such as mental health, flaws in interpreter accuracy results in mental health diagnoses errors and resulted in delaying treatments (Jacobs, Shepard, Suaya & Stone, 2004). Assistance is required from health care providers to provide specialized interpreter education to ensure quality health care when using translation services.
The Kaiser Permanente Clinician Cultural and Linguistic Assessment (CCLA) Initiative recognizes that language differences between patients and clinicians create barriers to health care and jeopardizes health of patients. This initiative’s goal is to create effective communication assessment tool to ensure quality of care to patients with language barriers. Even though many clinicians’ will come across patients with limited English proficiency, and will work practice medicine using language interpreter, but only few will receive formal training to work effectively using translation services (Searight, 2009).
Access to Care and Language
Study analyzed relationship of language with access to care and health status. Data consisted of older adults that spoke only English (EO), English proficient (EP), or had limited English proficiency (LEP). Results revealed that older adults with limited English proficiency had much worse access to care and they were nearly twice more likely to lack a usual source of care than EO speakers. Furthermore this study shows that LEP group had poorer health and increased risk of delaying medical care than EO and EP speakers ((Kim, G., Worely, C, Allren, R., Vinson, L, Crowther, M., Parmelee, P., & Chiriboga, D. (2011)..
Study Limitations
Limitations of this study should be noted. Current study did not consider differences between subgroups of Asian Americans. Given that subgroups within the Asian American culture are dissimilar in terms of their language use, immigration history and culture, differences among this group must be further explored. In addition, past studies have confirmed major differences in health status among the sub group falling under Asian Americans.
Hypothesis and Research Question
For the quantitative component of this study, it’s hypostasized that Elderly Asian American Immigrants, with limited English proficiency (LEP) are less likely to use health services, and are at higher risk for poorer physical and mental health than the non-immigrant English speaking population. For the qualitative component, the research examines the importance of language on Asian American Health.
Methods
Research Designs This study has quantitative and qualitative components. Quantitative component of this will be a cross-sectional survey to collect data. Cross sectional survey would be a questionnaire that collects data on Asian Indian immigrants, and their utilization of health related services in the United States, as of January 1st, 2012. This survey will determine the relationship between two factors English proficiency and Qualitative component of this study will be gathered through 15-minutes face-to-face s interview to address the quality of care received by this group.
Sample
Fifty Asian Indian immigrants with LEP will be recruited through convenience sampling for this quantitative study. The anticipated demographic characteristics of the participant in this study are: over age 50, dealing with one or more chronic illness themselves or of their spouses, low socioeconomic status, and have immigrated to the United States in the last 10 years.
To recruit participants’ flyers written in Hindi and Punjabi will be posted at the Hindu and Sikh temples located in San Jose. Furthermore, outreach will be done to staff and volunteers at the temples to help recruit individuals who might not seen or weren’t able to read the flyers. Moreover flyers will also be distributed at Indian parade taking place oan auspicious holiday, celebrated by people of India.
Study Site
The study will be conducted at the Hindu, and Sikh temples. Participants will stop by in the designated conference room to complete the questionnaire. Survey questionnaire will be administrated by one of the bilingual temple staff members or volunteers. Consents will be signed by survey administrators to ensure participant confidentiality.
The qualitative component, will take place in the participants’ homes. If the participant agrees to be part of the qualitative portion, the researcher will schedule home visits.
Variables and Measurements
In the past, research has linked language problems to health care and health status. Language barriers are linked to access, qualify and overall dissatisfaction with health care (Ponce, 2005). The dependable variable in this study is overall health status of Asian American Indians. The independent variable is their proficiency of English language.
The quantitative component will use the self-report questionnaire which will explore demographic information including Language, health care utilization and access to health care. The first part of the questionnaire is the demographic portion that will provide information on participants’ age, for how long they have lived the United States, and how well they speak English.
The second part of the questionnaire will be about health care utilization, and access. The questions in the section address the number of doctor visits in the last 12 months, and how well they understood the doctor and prescribed medication.
Qualitative portion of this study will explore qualify of health care among this group. Open ended questions will allow the participants to talk about quality of health care in the United States. This portion of the study will provide information participants preventative care knowledge such as their diet.
Prior to commencing both qualitative and quantitative portion of this study, questionnaire will be presented to health care access and utilization experts. In addition, face validity will be established to see if the questions are asking what they are meant to ask.
Human Subjects Considerations
All participants will receive written informed consents forms. Verbal description will also be read to the participants in this study. Participants will be assured about their confidentiality and anonymity. It will be explained to the participant that their responses for both qualitative and quantitative portion will be kept anonymous and confidential. For further protection for all participates, this proposal will need to be reviewed and approved by Santa Clara University’s Institutional Review Board.

Self-Completion Questionnaires
Self-completion (also called self-administered) questionnaires generally are the least expensive and easiest to implement survey data collection mode, placing the smallest demand on staff, equipment, and other resources. The most widely used application of self-completion questionnaires is in mailed surveys, whereby a questionnaire and a letter are sent via standard mail to a sample of persons whose names and addresses are available. The respondents are asked to complete the questionnaire and return it to the researchers using a postage-paid, preaddressed return envelope that is enclosed with the questionnaire.

References
Diwan, S. & Jonnalagadda, S. (2001). Social Integration and Health among Asian Indian Immigrants in the United States. Social Work Practice witht eh Asian American Elderly (pp. 45-62). Atlanta, GA: Haworth Press.
Hutchinson, E. D., & Charlesworth, L. W. (2008). Theoretical perspectives on human behavior. In E. D. Hutchinson (Ed.), Dimensions of human behavior: Person and environment (3rd ed. pp. 37-76). Thousand Oaks, CA: Sage.
Jacobs, E., Shepard, D., Suaya, J. & Stone, E. (2004). Overcoming language barriers in health care: Costs and benefit of interpreter services. American Journal of Public Health, 94(5)866-869.
Kim, G., Worley, C., Allen, R., Vinson, L., Crowther, M., Parmelee, P. & Chiriboga, D. (2011). Vulnerability of older Latino and Asian immigrants with limited English proficiency. The American Geriatric Society, 59(7), 1246-1252.
Lee, H. & Vang, S. (2010). Barriers to cancer screening in Hmong Americans: The influxes of health care accessibility, culture, and cancer literacy. J Community health, 35, 302-314.
McLeroy, K., Bibeau, D., Steckler, A., & Glanz, K. (1988). An Ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351-377.
National Association of Social Workers Foundation. (2008). NASW foundation national programs: NASW Code of Ethics. Retrieved from http://www.socialworkers.org/pubs/code/default.asp
National Institute of Mental Health. (2011). Retrieved from www.nimh.nih.gov
Sakamoto, I. (2007). A critical examination of immigrant acculturation: Toward an Anti-oppressive social work model with immigrant adults in a pluralistic society. British Journal of Social Work, 37, 515-535.
Seargight, H. & Seargiht, B. (2009). Working with foreign language interpreters: Recommendations for Psychological Practice. Professional Psychology: Research and Practice. 40(5), 444-451.
Tang, G., Lanza, O., & Rodriguez, F. (2011). The Kaiser Permanente Clinician Cultural and Linguistic Assessment Initiative: Research and Development in patient provider language Concordance. American Journal of Public Health, 101(2), 205-208.
United States Census Bureau. (2010). 2010 Census Briefs: Nation’s Foreign-Born Population: 10
Retrieved from http://2010.census.gov/2010census/data/

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...member of the health care team to increase compliance with delivery of culturally competent care? Address specific interventions to improve aspects of care related to each of the identified categories: Culturally competent, Culturally appropriate and Culturally Sensitive. Introduction As a registered nurse in the healthcare field, it is extremely important to be well versed and mindful of each and every patient’s cultural background. Nurses encounter people from all walks of life so having the appropriate background knowledge on patients coupled with being sensitive to their beliefs and traditions is paramount to being exceptional in the profession. In order to accomplish this, one needs to develop his/her health care skills to be culturally competent, culturally appropriate and culturally sensitive. Supportive Information The necessity of cultural competence continues to be a topic of discussion. In fact, the National Institutes of Health (NIH) has even recognized the importance of cultural competencies and its effect on the health care needs of culturally diverse individuals. To reiterate this, with help from local communities, the NIH developed and communicated programs designed to aid awareness to the growing population of minorities. Some examples of these NIH-funded projects include culture and cancer literacy among immigrant women, health intervention efforts for Korean-Americans having high blood pressure and environmental health literacy targeting...

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