Barriers to Health Care Access in 13 Asian American Communities

Abstract

Objective: To obtain and discuss in-depth information on health care use in Asian Americans (AAs). Methods: Nineteen focus groups were conducted in 174 adults from 13 AA communities in Montgomery County, Maryland. MAX QDA software was used to analyze qualitative data. Results: Financial, physical, communication, and cultural attitudes were 4 major barriers to accessing health care. Underrepresented communities reported unique additional barriers, such as lack of screening opportunities and interpretation services due to lack of resources in the communities. Conclusions: Future studies, public health policy, and funding resources should consider including underrepresented AA subgroups and reflect their needs.

Racial and Ethnic Disparities in Health Among Employees at Large Firms

“…Qualitative research suggests that Asian Americans are less likely to seek care from medical providers due to cultural and linguistic barriers. 11 Our findings are similar to those of Burton et al 5 Those authors also found that Asians had the smallest percentage of employees at high risk in 2009 whereas African Americans had the highest prevalence of four health risks (ie, obesity, blood pressure, safety belt use, and physical activity). The average number of risks among African American employees was significantly higher than that among other ethnic groups after adjusting for age and sex.…”

Changing demographics of cervical cancer in the United States (1973–2008)

“…These women may have had less access to preventative care in their countries of origin. In addition, many cultural and language barriers to healthcare have been identified in this population [14,15]. Attention focused on improving screening, early detection and prevention in these groups will be beneficial.…”

Shared Decision Making Among Clinicians and Asian American and Pacific Islander Sexual and Gender Minorities: An Intersectional Approach to Address a Critical Care Gap

“…[19][20][21] Guided by a SDM conceptual model, 3 we identify common experiences of AAPI SGM that fall into three themes: (1) AAPI Heterogeneity, (2) SGM Stigma, and (3) Multiple Minority Group Identities and Sources of Discrimination (Table 1). [4][5][6][7][8]10,12,13,18,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] We created three case studies to illustrate the intersectional issues that can occur in reallife patient-provider encounters among AAPI SGM. We outline potential strategies for clinics and clinicians to improve cultural competency, communication, and SDM (Table 2).…”

“…However, AAPI SGM may share cultural expectations that support an authoritarian relational structure in patient-provider relationships. 32,48 Dr. Steve may have attributed Michelle's confusion to a lack of English proficiency because of heteronormative assumptions, as well as the implicit racial bias and sentiments that AAPIs are ''perpetual foreigners. '' 30 Sentiments that AAPIs are ''not American enough'' prevail throughout U.S. history and continue to influence social interactions today (Table 1).…”

“…He does not disclose his immigration status for fear of further antagonizing Dr. Molly and being denied treatment. Socioeconomic status, class Ethnicity and culture (e.g., role of non-western medicine, religion, and spirituality) 22,25,26 Language proficiency and health literacy 22,25,26 Racial stereotypes (e.g., ''model minorities'' against whom other racial minorities should be compared; ''perpetual foreigners'' who are never American enough) [27][28][29][30][31] Patients Lack of access to AAPI SGM-specific resources 32,33 Language barriers in communication with providers 7,33,34 Culturally specific norms, beliefs, and attitudes about privacy, family obligations and expectations, and relationships with authorities and experts 10 Fear of deportation or detention 12 Cultural fatalism and perceived lack of treatment efficacy 22 Providers Presumptions based on race or ethnicity (e.g., underestimation of risk in stereotyped model minority populations) [4][5][6]8 Aggregating AAPI instead of noting differing customs and experiences that may vary by ethnicity 10,13 Unconscious biases that lead to misinterpretation of health information [4][5][6]8 Communication barriers (e.g., limited English proficiency and health literacy) 7 AAPI SGM stigma Fear of prejudice and rejection [27][28][29] Internalized racial and anti-SGM prejudice [27][28][29] Fear of being outed [27]…”