Source: UNIV OF MINNESOTA submitted to NRP
HEALTH LITERACY OF ASIAN AMERICAN REFUGEE PARENTS AND HEALTH DISPARITIES OF THEIR CHILDREN
Sponsoring Institution
State Agricultural Experiment Station
Project Status
COMPLETE
Funding Source
STATE
Reporting Frequency
Annual
Accession No.
0210947
Grant No.
(N/A)
Cumulative Award Amt.
(N/A)
Proposal No.
(N/A)
Multistate No.
(N/A)
Project Start Date
Jul 1, 2010
Project End Date
Jun 30, 2015
Grant Year
(N/A)
Program Code
[(N/A)]- (N/A)
Recipient Organization
UNIV OF MINNESOTA
(N/A)
ST PAUL,MN 55108
Performing Department
School of Social Work
Non Technical Summary
Recently, health literacy has emerged as an important research area in the medical and public health fields due to its significant association with health disparity. According to the Institute of Medicine (IOM, 1999), health literacy is defined as "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions." It has been widely reported that immigrants and refugees who recently arrived in the U.S., attain less education, or live in poverty have the lowest levels of health literacy. Research has found that people with low health literacy have difficulty in navigating the health care system, tend to underutilize health services, and report poorer health and mental health outcomes. For instance, Baker et al.s (1996) qualitative study with 60 illiterate or low-literate patients identified five main literacy challenges these participants faced: (1) navigating the health care system, (2) completing forms, (3) following medication instructions, (4) interacting with health care providers, and (5) understanding appointment slips. Individuals with inadequate health literacy also report poorer physical and mental health functioning, along with having less knowledge and understanding of chronic diseases, physicians instructions, and health-related websites (Baker, Parker, Williams, Clark, & Nurss, 1997; Wolf, Gazmararian, & Baker, 2005). Adults low level of health literacy not only impacts their own health disparity, but also their childrens health outcomes. In Yin, Johnson, Mendelsohn, Abrams, Sanders, and Dreyers study (2009) with 6100 parents from the 2003 NAAL, parents were asked to complete a 13-item health literacy survey addressing tasks related to children. The study found that 1 in 4 parents have limited health literacy skills and only 1 in 7 parents are categorized as having proficient health literacy. About 70% of the parents in the study had difficulty filling out insurance forms, 46% were unable to follow directions for medication, 50% could not determine the healthy weight of a person, and 50% were not able to determine when children should receive their immunizations; yet 95% of parents were able to circle the date of an appointment on a hospital appointment slip. Furthermore, Betz, Ruccione, Messke, Smith, and Changs review (2008) of parents health literacy and child health outcomes found parents with limited English proficiency to be more likely to report their children as ill, less likely to use medical services when needed, and uninsured; additionally, these parents reported lower levels of parental education and spent longer time in emergency care. Although health literacy has been considered to be a critical factor in terms of health disparity and childrens health outcomes, there is a dearth of literature focused on immigrant and refugee parents, particularly addressing the Asian American community. Consequently, a deeper understanding of parents health literacy and its impact on childrens health is necessary and timely.
Animal Health Component
(N/A)
Research Effort Categories
Basic
(N/A)
Applied
(N/A)
Developmental
(N/A)
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
8056010302050%
8056050302050%
Knowledge Area
805 - Community Institutions, Health, and Social Services;

Subject Of Investigation
6010 - Individuals; 6050 - Communities, areas, and regions;

Field Of Science
3020 - Education;
Goals / Objectives
The proposed study aims to investigate the level of health literacy that is related to children among Asian American immigrant and refugee parents. Through formative research methodologies, this study aims to explore relevant socio-cultural-spiritual factors contributing to poor levels of health literacy. Primary objectives of this study are threefold: 1. To assess the level of health literacy of refugee parents of minors, 2. To identify and explore factors associated with low levels of health literacy among refugee parents, and 3. To engage refugee parents in identifying potential intervention strategies that would prove culturally effective in increasing levels of child-focused health literacy. This study will focus on Hmong American refugees, the largest Asian American refugee population in Minnesota. The studys findings will help to customize educational messages and future intervention strategies aimed to raise parents health literacy regarding their children, which will ultimately enhance childrens health and welfare.
Project Methods
Research Design: There is a dearth of literature specific to child-focused health literacy among the Asian American refugee population. Therefore, this study will carry out exploratory, formative, and mixed methods research via a series of focus groups (YEAR 1) and subsequent survey (YEARs 2 and 3), using a community-based participatory research (CBPR) approach. In YEAR 1, qualitative research efforts will generate information that will guide the quantitative research in YEARs 2 and 3. This is an appropriate approach for this topic as too little information currently exists to design a rigorous quantitative investigation. The qualitative research will produce themes and rich details as to the lived experience of participants, which will then be developed into relevant research variables, hypotheses, and theories for quantitative research, to be conducted in YEARs 2 and 3. This study will collect both qualitative and quantitative data from two sources: (1) health care professionals serving Hmong American parents and children in area hospitals, community-based health centers, and clinics; and (2) Hmong parents whose children are minors. Therefore, two types of focus groups will be conducted: 2-3 focus groups with 5-7 health services providers and 2-3 focus groups with 5-7 Hmong parents. Based on this qualitative information, a questionnaire will be developed in YEARs 2 and 3 and quantitative interviews will be conducted with 100 Hmong parents. Community-Based Participatory Research Approach (CBPR): CBPR is useful for recognizing the cultural and political context of the community under consideration (McQuiston, et al., 2001; Zimmerman, et al., 1997), involving community members in the design and conduct of a study (Baker et al., 2001), and allowing better response to vulnerable populations (Minkler, 2000). A four-member Community-University Advisory Board (CUAB) has been established, consisting of three community agency leaders (see table below). These partnerships stem from the School of Social Works annual health literacy conference and form a tangible connection to local AAPI communities. This approach will permit substantive involvement of community members in all phases of the project. The CUAB will meet monthly during the first year to direct the project, and will continue active involvement throughout the duration of the research program. Data Analysis: Qualitative analysis will be conducted using grounded theory (Glaser, 1978; 1992; Strauss, 1987; Strauss & Corbin, 1990) and ATLAS. ti V5.0 (Muhr, 2005), a software for qualitative data analysis. For quantitative data analysis, STATA 9.0 will be used for univariate, bivariate, and multivariate data analysis. The community partners will be involved in every aspect of data analysis.

Progress 07/01/10 to 06/30/15

Outputs
Target Audience:The target audiences for the research project are Asian American immigrants and their children. Our study includes nine subgroups of Asian Americans including Chinese, Korean, Filipino, Vietnamese, Cambodian, Laotian, Asian Indian, Hmong, and Japanese. We also target health and mental health care professionals working with Asian American immigrants and refugees. Lastly our target audience inlcudedpolicy makers and reserachers working in health disparity issues in government and universities. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?I developed one online modules titled "Health and Mental Health Literacy & their Link to Health Disparities in Immigrant and Refugee Families: An Overview & Implications for Practice" (1.5 credis). How have the results been disseminated to communities of interest?I disseminated the research findings via publishing articles, presenting at the coferences, and educating social workers by developing online modules. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? I have published 9 articles in the topic of health and cancer literacy among Asian American immigrants and refugees. I also presented research findings in local and national conferences.

Publications

  • Type: Journal Articles Status: Published Year Published: 2015 Citation: Lee, H.Y., Kim, J.H., & Merghini, J. (2015). Physical activity and self-rated health status among elderly cancer survivors: Results from the 2004 National Long-Term Care Survey. Oncology Nursing Forum, 42(6), 614-624
  • Type: Journal Articles Status: Published Year Published: 2015 Citation: Lee, H.Y., Rhee, G. D, & Kim, N.G. D (2015). A mediation model of the association of cancer literacy with cancer screening behavior in Korean adults. Health and Social Care in the Community, doi: 10.1111/hsc.12243
  • Type: Journal Articles Status: Published Year Published: 2015 Citation: 5. Lee, H.Y., Kwon, M., Vang, S.D, DeWolfe, J., Kim, N.K.D, Lee, D.K.D, & Yeung, M. (2015). Disparities in Human Papillomavirus Virus vaccine literacy and vaccine completion among Asian American Pacific Islander undergraduates: Implications for cancer health equity. Journal of American College Health, 63(5), 316-323.
  • Type: Journal Articles Status: Published Year Published: 2015 Citation: Lee, H.Y., Kim, N.K.F, Rhee, T.G. D, & Ahluwalia, J.S. (2015). Health literacy as a social determinant of health in Asian American immigrants: Findings from a population-based survey in California. Journal of General Internal Medicine, 30(8), 1118-1124.
  • Type: Journal Articles Status: Published Year Published: 2015 Citation: Lightfoot, E. & Lee, H.Y. (2015). Professional international service learning as an international service learning opportunity appropriate for graduate or professional students. International Education Journal: Comparative Perspectives, 14(1).
  • Type: Journal Articles Status: Published Year Published: 2015 Citation: Lee, H.Y., Yang, P. D, Lee,D. K.U, & Ghebre, R. (2015). Cervical cancer screening behavior in underserved Hmong-American immigrant women. American Journal of Health Behavior, 39(3), 301-307.
  • Type: Journal Articles Status: Published Year Published: 2015 Citation: Arriaza, P., Nedjat-Haiem, F., Lee, H.Y., & Martin, S. (2015). Guidelines for conducting rigorous health care psychosocial cross-cultural/language qualitative research. Social Work in Public Health, 30(1), 75-87.
  • Type: Journal Articles Status: Published Year Published: 2015 Citation: Lee, H.Y., Lee, J.W. D, & Kim, N.K. D (2015). Gender differences in health literacy among Korean Adults: Do women have a higher level of health literacy than men? American Journal of Mens Health.
  • Type: Journal Articles Status: Published Year Published: 2015 Citation: Lee, H.Y., & Vang, S. D (2015). Cultural beliefs and clinical breast examination in Hmong American women: The crucial role of modesty. Journal of Immigrant and Minority Health, 17(3), 746-755.


Progress 10/01/13 to 09/30/14

Outputs
Target Audience: The target audiences for the research project are Asian American immigrants and their children. Our study includes nine subgroups of Asian Americans including Chinese, Korean, Filipino, Vietnamese, Cambodian, Laotian, Asian Indian, Hmong, and Japanese. We also target health and mental health care professionals working with Asian American immigrants and refugees. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Based on the data collected through current project, online modules were developed to educate social workers. The presentations made at the conferences also provided contiuning education (CE) credits for social workers, nurses, medical doctors, and dentists. How have the results been disseminated to communities of interest? We disseminated the research findings through online modules, journal articles, and local and national conferences. What do you plan to do during the next reporting period to accomplish the goals? Our research team plans to analyse the qualitative data we collected to publish another article on definition of health literacy by the Asian American immigrants and refugees. By extending the topic to include mental health literacy, our research team will conduct a survey among Asian American immigrant and refugee parents. Lastly, we will continue to analyze the California Health Information Survey (2007 Data) to investigate the impact of parental health literacy on children health and mental health outcome among Asian American immigrants.

Impacts
What was accomplished under these goals? During the FY 2014, I have published eight journal articles and delivered four presentations at local and national conferences. I have also developed 1.5-hour online module that aims to educate social workers and health and mental health care professionals. One article is under review and another article is almost completed and plan to submit during winter break.

Publications

  • Type: Journal Articles Status: Published Year Published: 2014 Citation: Assiaza, P., Nedjat-Haiem, F., Lee, H.Y., Shibusawa, T., & Martin, S. (2014). Guidelines for conducting rigorous health care psychosocial cross-cultural/language qualitative research. Public Health in Social Work. Online first published, DOI: 10.1080/19371918.2014.938394
  • Type: Journal Articles Status: Published Year Published: 2014 Citation: BrintzenhofeSoc, Davis, C., Kaser, K., Lee, H.Y., Nedjat-Haiem, F., Oktay, J.S., Zabora, J., & Zebrack, B. (2014). Screening for Psychosocial Distress: A National Survey of Oncology Social Workers, Journal of Psychosocial Oncology. Online first published. http://dx.doi.org/10.1080/07347332.2014.977416.
  • Type: Journal Articles Status: Published Year Published: 2014 Citation: Lee, H.Y., Choi, J, & Lee, M. (2014). Health literacy in an underserved immigrant population: New implications toward achieving health equity. Asian American Journal of Psychology. Advance online publication, August 11, 2014. http://dx.doi.org/10.1037/a0037425
  • Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Khuu, B. D, Lee, H.Y., Shin, J.H.M, & Lee, R. (2014). Parental Health Literacy and Childrens Health Outcomes among Immigrants and Refugees. Poster Presentation. 6th Annual Health Literacy Research Conference, Bethesda, Maryland.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Khuu, B. D, Lee, H.Y., Shin, J.H.M, & Lee, R. (2014). Parental Health Literacy and Childrens Health Outcomes among Immigrants and Refugees. Poster Presentation. Annual Conference of Council on Social Work Education. Washington D.C.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Lee, H.Y., Choi, J.K., & Lee, M.H. D (2014). Health Literacy among Underserved Immigrant Population: New Directions for Achieving Health Equity. Poster Presentation. Annual Conference of Council on Social Work Education. Washington D.C.
  • Type: Journal Articles Status: Published Year Published: 2014 Citation: Lee, H.Y., Stange, M.J. M, & Ahluwalia, J.S. (2014). Breast cancer screening behavior among Korean American immigrant women: Findings from Health Belief Model. Journal of Transcultural Nursing. Advance online publication, May 21, 2014. DOI: 1043659614526457
  • Type: Journal Articles Status: Published Year Published: 2014 Citation: Lee, H.Y., Lee, J.W. , & Kim, N.G. (2014). Gender differences in levels of and factors associated with health literacy in Korean adults. American Journal of Mens Health. Advance online publication, August 13, 2014. DOI: 10.1177/1557988314545485
  • Type: Journal Articles Status: Published Year Published: 2014 Citation: Lee, H.Y., & Lightfoot, E. (2014). A Culture-embedded social problem of elder mistreatment: A review of international literature among Asian elders. Journal of Aggression, Maltreatment, and Trauma, 23, 5-19.
  • Type: Conference Papers and Presentations Status: Published Year Published: 2014 Citation: Lee, H.Y., Rhee, G. D, Kim, N.G. D, Ahluwalia, J.S. (2014). Health Literacy as a Social Determinant of Health in Asian American Immigrants: Findings from Population-Based Survey in California. Paper presentation. 6th Annual Health Literacy Research Conference, Bethesda, Maryland.


Progress 01/01/13 to 09/30/13

Outputs
Target Audience: The target audiences for the research project are Asian American immigrants and their children. Our study includes eight subgroups of Asian Americans including Chinese, Korean, Filipino, Vietnamese, Cambodian, Asian Indian, Hmong, and Japanese. We also target health and mental health care professionals working with Asian American immigrants and refugees. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Based on the outcomes from the qualitative interviews, focus groups, and comprehensive literature review, a two-hour, online health literacy module that focused on parents’ health literacy on children’s health outcome was developed to train social workers working with immigrant children and family in the United States. How have the results been disseminated to communities of interest? A poster which described the research’s findings was created and presented at the 119th Annual Training Conference and Expo of the Minnesota Social Services Association. The PI was invited to present preliminary research findings of the study and made few presentations including Pusan National University and Ehwa Women’s University in Korea. Several conference abstracts will be prepared and submitted during next year to present at local and national level conferences. One manuscript is currently preparing to submit to an academic journal within this year. What do you plan to do during the next reporting period to accomplish the goals? For next year, it is planned to develop a survey with immigrant and refugee populations in Minnesota to generate baseline information to develop intervention for improving health literacy in this population. We also plan to analyze the data from 2007 California Health Interview Survey (CHIS), a population-based survey in California, to investigate the relationship between parents’ health literacy and its impact on children’s health outcome. A NIH grant (e.g., R21) will be pursued to design and develop intervention to reduce health disparity in these underserved immigrant and refugee communities.

Impacts
What was accomplished under these goals? During this 2013 Year (1/1/13 - 9/30/13), interviews with 20 health and mental health care professionals and three focus groups with case managers, medical assistances, nurses, and front desk workers were conducted at community-based clinics and agencies. We transcribed all of the individual interviews and focus group in verbatim. Currently we are analyzing the qualitative data using a ground theory approach. With the findings from the analysis, we will publish few articles and submit academic journals.

Publications

  • Type: Journal Articles Status: Published Year Published: 2013 Citation: Lee, H.Y., & Jin, S.W. (2013). Older Korean cancer survivors depression and coping: Directions toward culturally competent intervention. Journal of Psychosocial Oncology, 31(4), 357-376.
  • Type: Journal Articles Status: Published Year Published: 2013 Citation: Lee, H.Y. & Jung, Y. (2013). Older Korean American mens prostate cancer screening behavior: The prime role of culture. Journal of Immigrant and Minority Health, 15(6), 1030-1037
  • Type: Journal Articles Status: Published Year Published: 2013 Citation: Lee, H.Y., Lee, S. E., Yoon, H. S., & Im, H. (2013). Definition of financial abuse among Korean elders: Does social and cultural context impact the construction? Journal of Aggression, Maltreatment, and Trauma, 22(5), 527-540
  • Type: Journal Articles Status: Accepted Year Published: 2013 Citation: Lee, H.Y., & Vang, S. (In press). Cultural beliefs and clinical breast examination in Hmong American women: The crucial role of modesty. Journal of Immigrant and Minority Health.
  • Type: Journal Articles Status: Accepted Year Published: 2013 Citation: Lee, H.Y., Yoon, H. S., Kwon, J. H., Yoon, J. Y., Park, E. S., Nam, R., Kang, S. B., & Park, K. H. (In press). Perception and help-seeking intention of intimate partner violence in later life: An International perspectives. Journal of Aggression, Maltreatment, and Trauma.
  • Type: Journal Articles Status: Accepted Year Published: 2013 Citation: Lee, H.Y., & Lightfoot, E. (In press). A Culture-embedded social problem of elder mistreatment: A review of international literature among Asian elders. Journal of Aggression, Maltreatment, and Trauma.
  • Type: Journal Articles Status: Accepted Year Published: 2013 Citation: Lightfoot, E. & Lee, H.Y. (In press). Elder mistreatment among Asians and Asian Americans: New directions toward prevention, intervention, and policy. Journal of Aggression, Maltreatment, and Trauma.


Progress 01/01/12 to 12/31/12

Outputs
OUTPUTS: There is a dearth of literature specific to child-focused health literacy among the Asian American refugee population. Therefore, this study will carry out exploratory, formative, and mixed methods research via a series of focus groups (YEAR 1) and subsequent survey (YEARs 2 and 3), using a community-based participatory research (CBPR) approach. During this 2012 Year (10/1/11 - 9/30/12), interview with 17 health and mental health care professionals and a focus group with case managers were conducted. Prior to the interviews, an application to get Institutional Review Board (IRB) approval has been completed to conduct a series of focus group and the qualitative interview. An application to change questions of the semi-structural questionnaire was submitted to IRB and an approval was obtained. Based on the outcomes from the qualitative interviews and comprehensive literature review, a two-hour, online health literacy module was developed to train social workers working with children and family and health care professionals and social service providers in health and mental health care settings in the United States. A poster which described the research's findings was created and presented at the 118th Annual Training Conference and Expo of the Minnesota Social Services Association. Two more focus groups will be conducted with two groups of people: (1) 5-7 front line case managers in a clinic where most of patients are immigrants and refugees and (2) 5-7 interpreters and health care professionals serving Hmong American parents and children in a community-based health centers. Several conference abstracts will be prepared and submitted during next year to present at local and national level conferences and a few manuscripts will be submitted based on the findings from the research. PARTICIPANTS: Those who worked on the project include research assistants, Belle Khuu and Jihee Shin, and co-investigator, Dr. Richard Lee, at the Department of Psychology. Four community agencies have been working with the PI as research partners: Wilder Foundation Mental Health Unit (Dr. Pahua Yang; Minnesota Health Literacy Partnership (Chair: Alisha Ellwood); and Hmong American Partnership (HAP) (Executive Director: Bao Vang) as research partners and serve as community advisory board. TARGET AUDIENCES: The target audiences for the research project are Hmong refugee parents who are currently raising minor children. This study also conducts individual in-depth interviews, focus groups, and survey with health professionals who are working with Hmong refugee parents. PROJECT MODIFICATIONS: N/A

Impacts
The findings from the interviews with 17 health and mental health care professional and the focus group with case managers informed (1) the definition of health literacy voiced by the health care professionals, (2) the need of health literacy screening tool, (3) the difficulty in navigating the health care system, completing forms, and following medication instructions, and (4) difficulty in interacting with health care providers and understanding appointment slips. The research participants further reported that health literacy impacts timely use of existing services, particularly among underserved immigrant and refugee populations, due to lack of understanding of U.S. health care system. With regard to children's health, the research participants articulated that immigrant parents' low health literacy is associated with difficulty in timely access to health care system when children are sick, following instructions for proper dosing of medicine, and reading nutrition and drug labels. The research participants witnessed that children of parents with low health literacy had higher rates of hospitalizations and emergency department visits and were more likely to miss school because of an illness. Increasing health literacy levels among immigrant and refugee parents with young children may positively impact health care utilization behavior, observance of medication regimens, and adherence to recommended immunization guidelines. In short, increased health literacy levels will reduce health disparities among underserved populations, particularly underserved children. For next year, it is planned to develop a survey with immigrant and refugee populations in Minnesota to generate baseline information to develop intervention for improving health literacy in this population. Few NIH grants will be pursued to design and develop intervention to reduce health disparity, in these underserved immigrant and refugee communities.

Publications

  • During this 2012 reporting period, seven articles have been either accepted to publish or published in medical, social work, and public health journals. Moreover, seven manuscripts are currently under review. The list of articles that have been already published is below:
  • Lee, H.Y., Choi, J., & Park, J.H. (2012). The Role of primary care physician in cancer literacy: A new direction to reduce health disparity in immigrant population. Health Education Journal.
  • Lee, H.Y., & Im, H. J. (2012). Colorectal Cancer Screening among Korean American Immigrants: Unraveling the Influence of Culture. Journal of Health Care for the Poor and Underserved.
  • Lee, H.Y., & Choi, J. K. (2012). Pathway to Health Literacy among Korean American Immigrants: The Mediating Role of English Proficiency. Journal of Human Behavior in the Social Environment, 22(3), 255-269.
  • Lee, H.Y., Lee, S. E., & Eaton, C. (2012). Exploring definition of financial abuse in elderly Korean immigrants: The contribution of traditional cultural values. Journal of Elder Abuse and Neglect, 24(4), 293-311.


Progress 01/01/11 to 12/31/11

Outputs
OUTPUTS: There is a dearth of literature specific to child-focused health literacy among the Asian American refugee population. Therefore, this study will carry out exploratory, formative, and mixed methods research via a series of focus groups (YEAR 1) and subsequent survey (YEARs 2 and 3), using a community-based participatory research (CBPR) approach. During this 2011 Year (1/1/11-12/31/11), comprehensive literature review has been conducted to prepare focus group questions. Based on the literature review, a two-hour, online health literacy module was developed to train health care professionals, social service providers, and children social workers in Minnesota. During this time period, an application to get Institutional Review Board (IRB) approval has been completed to conduct a series of focus group. With the IRB approval, two individual in-depth interviews with clinical psychologist who are working with Hmong refugee parents and children were conducted. Seven more in-depth interviews will be conducted during the 2012 Spring Semester (1/11/12-5/30/12). Furthermore, three focus groups will be conducted with two group of people: (1) 5-7 health care professionals serving Hmong American parents and children in area hospitals, community-based health centers, and clinics; and (2) 5-7 Hmong parents whose children are minors. These focus groups will inform the researcher to develop a questionnaire in the second half of the Year 2.The focus groups' findings will be presented at a local and national level conference and will be published in an academic journal. PARTICIPANTS: Those who worked on the project include Pa Nhia Yang, Seokwon Jin, and Jo Quanbeck from the University of Minnesota. Four community agencies have been working with the PI as research partners: Minnesota Asian/American Health Coalition (MA/AHC) (Executive Director: Nancy Pomplun); Minnesota Health Literacy Partnership (Chair: Alisha Ellwood); Hmong American Partnership (HAP) (Executive Director: Bao Vang); and Wilder Foundation (Dr. Pahua Yang) as research partners and serve as community advisory board. TARGET AUDIENCES: The target audiences for the research project are Hmong refugee parents who are currently raising minor children. This study also conducts individual in-depth interviews, focus groups, and survey with health professionals who are working with Hmong refugee parents. PROJECT MODIFICATIONS: N/A

Impacts
Health literacy impacts timely use of existing services, particularly among underserved immigrant and refugee populations. Studies have found individuals with inadequate health literacy to report poorer physical and mental health functioning as well as to demonstrate less knowledge and understanding of chronic diseases, physicians' instructions, and health-related Web information. Furthermore, poor health literacy limits one's understanding of medical diagnoses or treatment regimens, such as breast cancer screening for women or early detection of prostate cancer for men. Fundamental challenges compound such barriers are: (1) navigating the health care system, (2) completing forms, (3) following medication instructions, (4) interacting with health care providers, and (5) understanding appointment slips. Recent studies have shown lower levels of health literacy among those with low education, older age, and low income levels, as well as among minority populations, a link that has been notable within the AAPI population. Low health literacy has also been a factor attributed to misunderstanding prescription drug medication regimens and subsequent medication non-adherence. For example, low levels of health literacy have been shown to do the following: have a negative impact on patients' ability to understand prescription drug labels, create difficulty in the patient-pharmacist relationship, enforce communication barriers, and cause difficulty in understanding medication counseling. Turning particular attention to children, parents' low health literacy is associated with difficulty in following instructions for proper dosing of medicine and reading nutrition and drug labels. Researchers systematically reviewed health literacy and child health outcomes where young children and parental literacy were variables of interest. This study revealed that children of parents with low health literacy had higher rates of hospitalizations and emergency department visits and were more likely to miss school because of an illness. Increasing health literacy levels among immigrant and refugee parents with young children may positively impact health care utilization behavior, observance of medication regimens, and adherence to recommended immunization guidelines. In short, increased health literacy levels will reduce health disparities among underserved populations, particularly underserved children. Therefore, it is anticipated that the in-depth interviews, focus groups, and surveys with the Hmong refugee parents and health professionals who are working with Hmong refugees will serve as an important first step to increase understanding of health disparity in the Hmong American community. Moreover, the study's findings will help to customize/develop educational messages and strategies on enhancing health literacy to the most vulnerable subgroups of Asian American immigrants and refugees in Minnesota. It is also planned that with the findings, few NIH grants will be pursued to design intervention to enhance health literacy, thereby reducing health disparity, in these underserved immigrant and refugee communities.

Publications

  • Lee, H., Rho, S. H., Vang, S., & Jin, S. (2011). The contribution of culture to Korean American women cervical cancer screening behavior. Ethnicity and Disease.
  • Lee, H., Yoon, H. S., Kwon, J. H., Yoon, J. Y., Park, E. S., Nam, R., Kang, S. B., & Park, K. H. (2012). Perception and help-seeking intention of intimate partner violence in later life: International perspectives. Journal of Aggression, Maltreatment, and Trauma.
  • Lee, H., Lee, S. E., Yoon, H. S., & Im, H. (2012). Definition of Financial Abuse among Korean Elders: Does Social and Cultural Context Impact the Construction? Journal of Aggression, Maltreatment, and Trauma.
  • Lee, H. & Lightfoot, E. (2012). A Culture-Embedded Social Problem of Elder Mistreatment: A Review of International Literature among Asian Elders. Journal of Aggression, Maltreatment, and Trauma and Neglect.


Progress 07/01/10 to 12/31/10

Outputs
OUTPUTS: There is a dearth of literature specific to child-focused health literacy among the Asian American refugee population. Therefore, this study will carry out exploratory, formative, and mixed methods research via a series of focus groups (YEAR 1) and subsequent survey (YEARs 2 and 3), using a community-based participatory research (CBPR) approach. During the last 2010 fall semester (07/01/10-12/30/10), comprehensive literature review has been conducted to prepare focus group questions. During this time period, an application to get Institutional Review Board (IRB) approval has been completed to conduct a series of focus group. With the IRB approval, two or three focus groups will be conducted during 2011 Spring semester (01/11/11-06/30/11) with two groups: (1) 5-7 health care professionals serving Hmong American parents and children in area hospitals, community-based health centers, and clinics; and (2) 5-7 Hmong parents whose children are minors. These focus groups will inform the researcher to develop a questionnaire in Year 2.The focus groups' findings will be presented at a local and national level conference and will be published in an academic journal. A four-member Community-University Advisory Board (CUAB) has been established, consisting of three community agency leaders. These partnerships stem from the School of Social Work's annual health literacy conference which the researcher helped inaugurate and form a tangible connection to local Asian Americans and Pacific Islanders communities. This approach will permit substantive involvement of community members in all phases of the project. The role and responsibility of the CUAB will include the following: (1) develop focus group questions, (2) guide a research approach that is culturally appropriate for the Hmong American community, (3) recruit research participants, (4) participate in data analysis, (5) contribute to community-based dissemination activities, and (6) provide guidance for development of intervention strategies and long-term funding plans. The CUAB will meet monthly during the first year to direct the project, and will continue active involvement throughout the duration of the research program. PARTICIPANTS: Those who worked on the project include Pa Nhia Yang, Seokwon Jin, and Hyojin Im from the University of Minnesota. Three community agencies have been working with the PI as research partners: Minnesota Asian/American Health Coalition (MA/AHC) (Executive Director: Nancy Pomplun); Minnesota Health Literacy Partnership (Chair: Alisha Ellwood); Hmong American Partnership (HAP) (Executive Director: Bao Vang) as research partners and serve as community advisory board. TARGET AUDIENCES: The target audiences for the research project are Hmong refugee parents who are currently raising minor children. This study also conducts focus groups with health professionals who are working with Hmong refugee parents. PROJECT MODIFICATIONS: There is no project modifications.

Impacts
Health literacy impacts timely use of existing services, particularly among underserved immigrant and refugee populations. Studies have found individuals with inadequate health literacy to report poorer physical and mental health functioning as well as to demonstrate less knowledge and understanding of chronic diseases, physicians' instructions, and health-related Web information. Furthermore, poor health literacy limits one's understanding of medical diagnoses or treatment regimens, such as breast cancer screening for women or early detection of prostate cancer for men. Fundamental challenges compound such barriers are: (1) navigating the health care system, (2) completing forms, (3) following medication instructions, (4) interacting with health care providers, and (5) understanding appointment slips. Recent studies have shown lower levels of health literacy among those with low education, older age, and low income levels, as well as among minority populations, a link that has been notable within the Asian Americans and Pacific Islanders population. Low health literacy has also been a factor attributed to misunderstanding prescription drug medication regimens and subsequent medication non-adherence. For example, low levels of health literacy have been shown to do the following: have a negative impact on patients' ability to understand prescription drug labels, create difficulty in the patient-pharmacist relationship, enforce communication barriers, and cause difficulty in understanding medication counseling. Turning particular attention to children, parents' low health literacy is associated with difficulty in following instructions for proper dosing of medicine and reading nutrition and drug labels. Researchers systematically reviewed health literacy and child health outcomes where young children and parental literacy were variables of interest. This study revealed that children of parents with low health literacy had higher rates of hospitalizations and emergency department visits and were more likely to miss school because of an illness. Increasing health literacy levels among immigrant and refugee parents with young children may positively impact health care utilization behavior, observance of medication regimens, and adherence to recommended immunization guidelines. In short, increased health literacy levels will reduce health disparities among underserved populations, particularly underserved children. Therefore, it is anticipated that the focus groups and surveys with the Hmong refugee parents and health professionals who are working with Hmong refugees will serve as an important first step to increase understanding of health disparity in the Hmong American community. Moreover, the study's findings will help to customize educational messages and strategies on enhancing health literacy to the most vulnerable subgroups of Asian American immigrants and refugees in Minnesota. It is also planned that with the findings, few NIH grants will be pursued to design intervention to enhance health literacy, thereby reducing health disparity, in these underserved immigrant and refugee communities.

Publications

  • During this 2010 reporting period, four articles have been either accepted to publish or published in medical, social work, and public health journals. Moreover, four manuscripts are currently under review. The list of articles are below:
  • Lee, H.Y., Lee, S. E., & Eaton, C. (2011). Definition of financial abuse in Korean elderly immigrants: Does culture play a role Journal of Elder Abuse and Neglect.
  • Lee, H.Y., Yoon, H.S., Shin, N.R., Kwon, J. H., Yoon, J. Y., Park, E. S., Nam, R., Kang, S. B., & Park, K. H. (2010). Elder mistreatment in Korea and the United States: Differences in Help-Seeking Behavior. Clinical Gerontologist.
  • Lee, H.Y., Lytle, K., Yang, P., & Lum, T. (2010). Mental health literacy in Southeast Asian elderly refugees: A barrier to recognizing and seeking help for depression. International Journal of Aging and Human Development.
  • Yoon, H. S., Lee, H., Park, E. S., Yoon, J. Y., Kwon, J. H., Park, K. H., Nam, R., & Kang, S. B. (2010). Effectiveness of the elder mistreatment prevention program for older persons. Journal of Community Welfare.
  • Lee, H.Y., Gibson, P., & Chaisson, R. (2010). Elderly Korean immigrants' socially and culturally constructed definitions of elder neglect. Journal of Aging Studies.


Progress 01/01/09 to 12/31/09

Outputs
OUTPUTS: With approval from the Office of Institutional Review Board at University of Minnesota (IRB Code Number: 0806S35441), the research projects qualitative interview with Hmong population was completed (n=30). The quantitative interview with Hmong Americans has been conducting, aiming to interview 200 Hmong and 96 interviews have been so far completed. Due to small size of Korean Americans residing in Minnesota, the researcher requested to change interview site from Twin Cities area to New York City and IRB approval is currently pending. 200 Korean Americans will be interviewed in New York City. The qualitative portion of the interview was analyzed and presented at the 62nd Annual Scientific Meeting of the Gerontological Society of America, November 21, 2009, Atlanta, Georgia and its title was Cancer literacy in elderly refugees: How much do the first generation Hmong Americans know about cancer The findings will be soon published in a medical journal. The quantitative interviews of the Hmong (n=96) are currently coded into SPSS and preliminary findings will be reported at 2011 conference of Association of Oncology Social Work. PARTICIPANTS: Those who worked on the project include Melissa Lundquist, Eunsu Ju, Pa Nhia Yang, and Pa Kou Yang from the University of Minnesota. Two community agencies have worked with the PI as research partners: 1) Korean Service Center (Executive Director: Yunju Park) and 2) Advancement of Association for the Advancement of Hmong Women in Minnesota (Executive Director: Ly Vang). The two agencies are currently helping research participant recruitment. TARGET AUDIENCES: The target audiences for the research project are Asian American cancer survivors, caregivers, health professionals who provide cancer care to Asian American cancer survivors, social workers, policy makers and administrators, and other professionals working with cancer survivors. PROJECT MODIFICATIONS: The interview site for Korean Americans has been changed from Twin Cities to New York City due to small population size of Korean Americans in Minnesota.

Impacts
The qualitative findings from the Hmong (n=30) informed low level of cancer literacy and concept on cancer prevention. Five themes emerged from the qualitative data: 1) no term or concept on cancer in Hmong language, 2) cancer as death sentence, 3) illiteracy on cancer prevention, 4) spiritual cause of cancer, and 5) shaman ceremony as cancer coping and treatment. Cancer literacy on etiology, treatment, and prevention were tremendously low in this population. The findings suggest that the Hmong have unique cultural views on cancer which is grounded on their socio-cultural-religious backgrounds. Furthermore, to date, no study has been conducted on the cultural barriers the Hmong population faces in undergoing cancer screenings. A systematic review of the literature was conducted to examine the existing knowledge regarding the barriers to cancer screening for Hmong Americans. A manuscript was written and accepted to one of prestigious public health journals, Journal of Community Health. This paper informed a few potential barriers to cancer screening. They include health access factors (type of health insurance, ethnicity of provider, low English proficiency, and years spent in the U.S.), cultural factors (belief in the spiritual etiology of diseases, patriarchal values, modesty, and mistrust of the western medical system), and cancer literacy factors (cancer and prevention illiteracy). These findings speak that the provision of cancer education to Hmong Americans is urgently needed to improve cancer literacy. Cancer education needs to be disseminated using multiple outlets, as many Hmong are illiterate in their own language and has no term or concept on cancer. The venues of education should be also evidence-informed and/or based and culturally competent, as the Hmong may not believe in the education or intervention offered, especially if it does not share many of the core tenets of Hmong beliefs in regard to meaning, etiology, prevention, and treatment of cancer. It is anticipated that the surveys with the Hmong and Korean Americans will serve as an important first step to increase understanding of cancer health disparity in Hmong and Korean Americans. The collected information will be utilized to identify culture and religion-specific cancer prevention beliefs and attitudes in order to reduce cancer burden in these populations. Moreover, the findings will help to customize/develop educational messages and strategies on cancer prevention or screening to the most vulnerable subgroups of Asian American immigrants and refugees in Minnesota. It is also planned that with the findings, few NIH grants will be pursued to design intervention to reduce cancer health disparity in these underserved immigrant and refugee communities.

Publications

  • During the 2009 reporting period, six articles have been wither accepted to publish or published in medical, social work, and public health journals. Moreover, one book chapter is currently in press. The list of articles are below: Lee, H. & Shin, N. R. (In press). Cultural View on and Response to Elder Mistreatment in Elderly Korean American Immigrants: A Social Development Intervention. Social Development Issues Lee, H., Lundquist, M., Ju, E.S., Liu, X., & Townsend, A. (In press). Colorectal cancer screening disparities in Asian Americans and Pacific Islanders: Which groups are the most vulnerable Ethnicity and Health. Lee, H., Park, E.J., & Lightfoot, E. (In press). When does a Battered Woman Seek Help from the Police The Role of Battered Womans Functionality. Journal of Family Violence Lee, H., Ju, E.S., & Lightfoot, E. (In press). The role of substance use by a perpetrator and a victim on the outcomes of intimate partner violence. Journal of Social Work Practice in Addiction. Lee, H. & Vang, S. (In press). Barriers to Cancer Screening in Hmong Americans: The Influence of Health Care Accessibility, Culture, and Cancer Literacy. Journal of Community Health. Lee, S., Lee, H., & Diwan, S. (In press). What do Korean American immigrants know about Alzheimers Disease (AD): The impact of acculturation and exposure to the disease on AD knowledge. International Journal of Geriatric Psychiatry Lee, H. (In press). Family violence in Asian Americans: Child abuse, intimate partner violence, and elder mistreatment. The Greenwood Encyclopedia of Asian American Issues Today, Greenwood publication: San Francisco.


Progress 01/01/08 to 12/31/08

Outputs
OUTPUTS: The Office of Institutional Review Board at University of Minnesota approved the research project. The IRB Code Number is 0806S35441 and the project's title is Exploring Cultural Beliefs of, Knowledge of, and Attitudes toward Cancer Screening in Asian American Immigrants and Refugees. Based on the literature review, a quantitative questionnaire has been developed for a community survey to explore attitude, belief,and knowledge toward cancer screening of Asian Americans. The quantitative questionnaire has been translated into Hmong and Korean languages by using back translation technique.Currently, two bilingual Hmong and Korean research assistants and one White research assistant are conducting the survey in order to have 200 Hmong Americans, 200 Korean Americans, and 200 Whites completed the interviews in Minnesota. Collected data has been entered into SPSS to generate preliminary findings. PARTICIPANTS: Those who worked on the project include Melissa Lundquist, Eunsu Ju, and Pa Kou Yang from the University of Minnesota. Two community agencies have worked with the PI as research partners: 1) Korean Service Center (Executive Director: Yunju Park) and 2) Advancement of Association for the Advancement of Hmong Women in Minnesota (Executive Director: Ly Vang). The two agencies are currently helping research participant recruitment. TARGET AUDIENCES: The target audiences for the research project are Asian American cancer survivors, caregivers, health professionals who provide cancer care to Asian American cancer survivors, social workers, policy makers and administrators, and other professionals working with cancer survivors. PROJECT MODIFICATIONS: There has not been any project modification in this research project.

Impacts
It is anticipated that the survey will serve as an important first step to increase understanding of cancer screening disparity in Hmong and Korean Americans, as compared to Whites. The collected information will be utilized to identify culture and religion-specific cancer prevention beliefs and attitudes in order to reduce cancer burden in these populations. Moreover, the study findings will help to develop educational messages and strategies on cancer prevention or screening to the most vulnerable subgroups of Asian American immigrants and refugees in Minnesota. Based on literature review on health belief, attitude and knowledge of cancer screening in Hmong Americans, one review article (Title: Spirit-Rooted Health Beliefs and its Role in Cancer Screening in Hmong Americans: Toward Reducing Cancer Health Disparity) is currently written to submit a medical journal. It is anticipated that this paper will assist state and national health professionals and policy makers to understand the role of religion on cancer screening disparity and to prepare ethnic-specific cancer prevention strategies among growing populations of Hmong refugees in Minnesota.

Publications

  • Lee, H., Lightfoot, E., & Edleson, J. (2008). Differences among battered mothers in their involvement with child protection services: Could the perpetrator's biological relationship to the child have an impact Children and Youth Services Review, 30, p. 1189-1197.
  • During the 2008 reporting period, one article has been published in a Journal, Children and Youth Services Review (see below), and another article (Title: Financial abuse in elderly Korean immigrants: Mixed analysis of the role of culture on perception and help-seeking intention) has been accepted to publish at Journal of Gerontological Social Work. One encyclopedia book chapter (Title: Family violence in Asian Americans: Child abuse, intimate partner violence,and elder mistreatment) was also accepted to publish at Greenwood Encyclopedia of Asian American Issues Today.


Progress 01/01/07 to 12/31/07

Outputs
OUTPUTS: Literature review has been conducted on health belief, attitude and meaning of cancer, quality of life, and access to and quality of cancer care. Based on the literature review, two focus groups with community directors, leaders, and health professionals have been performed to generate an interview guide for qualitative interviews with health professionals. Furthermore, a quantitative questionnaire has been developed for a community survey to explore Asian Americans' attitude, belief, and knowledge toward a cancer. In order to get University of Minnesota's IRB approval for the qualitative and quantitative interviews, IRB forms were filled out and submitted to the Office of Institutional Review Board. PARTICIPANTS: Those who worked on the project include Melissa Lundquist and Emily Strand from the University of Minnesota. TARGET AUDIENCES: The target audiences for the research project are Asian American cancer survivors, caregivers, health professionals who provide cancer care to Asian American cancer survivors, social workers, policy makers and administrators, and other professionals working with cancer survivors. PROJECT MODIFICATIONS: There has not been any project modification in this research project.

Impacts
Since this research project has just started since September 2007, there are no produced outcomes or impacts. However, it is anticipated that the proposed study will assist state and national policy makers to prepare for the impending high cancer incidence and cancer burden anticipated among growing populations of Asian American immigrants and refugees in Minnesota. This study will also serve as an important first step to increase the quality and duration of a healthy life and improve the well-being of members of this immigrant group who have cancer, and to eliminate health disparities among minority immigrant groups in general. Moreover, the study's findings will help to customize educational messages on cancer prevention or screening to the most vulnerable subgroups of Asian American immigrants and refugees.

Publications

  • No publications reported this period