low health literacy in asian american immigrant...
TRANSCRIPT
Low Health Literacy in Asian American
Immigrant Families: Implications on
Children’s Mental Health Equity
Hee Yun Lee, PhD, LICSW
Professor
Director of Research
School of Social Work
University of Minnesota, Twin Cities
Background: Health Literacy
(HL)
“Degree to which individuals have the
capacity to obtain, process, and
understand basic health information and
services needed to make appropriate
health decisions” (p. vi)
Ratzan and Parker (2000)
Background: Mental Health
Literacy (MHL)
“Knowledge and beliefs about mental
disorders which aid their recognition,
management or prevention”
(Jorm, 2012)
Why is Health Literacy Important?
• Impacts timely access to, and use of, existing
health services
• Related to…
– Limited awareness of health symptoms
– Lack of knowledge of where to seek services
– Limited ability in identifying illnesses
– Decreased health service utilization
Baker, Parker, Williams, Clark, & Nurss, 1997; Friedman & Hoffman-Goetz, 2008;
Lindau, Tomori, McCarville, & Bennett, 2001; Wolf, Gazmararian, & Baker, 2005
Importance of Health Literacy
• Limits an individual’s ability to communicate
to service provider
• Affects one’s understanding and ability to
follow health instructions
– 1 in 4 parents have limited health literacy skills
– One-third of U.S. adults are not able to perform
basic child wellness tasks
– Asian immigrants had lower HL than non-Latino
Whites
(Kutner Greenberg, Jin, & Paulsen, 2006; Yin et al., 2009, HY Lee)
Why is Mental Health Literacy
Important?
• Low knowledge about mental health disorders by the
general public
• Lack of understanding on how to recognize a
developing disorder
• Poor knowledge about effective self-help strategies
or how to seek help for one’s self and others
• Approx. 18% of the total U.S. population experienced
a mental health illness in 2014
(NIMH 2014; Jorm 2012)
Mental Health Literacy
Importance
• 13% of children (8 to 13 years old) had a
diagnosable mental health disorder in the last
year
• Asian Americans (AA) and Native
Hawaiians/Other Pacific Islanders had the
highest rates (21% and 22% respectively)
• AA may be of particular interest because:
– AA underutilize mental health services
– High level of stigma in AA populations(NIMH 2014; Jorm 2012)
Parents and Children
What about link between parents and children?
– Parents are in control of their children’s health
decisions
– Parents may be the gateway from which we could
address disparities in child mental health
outcomes
– Previous research supports relationship between
parental HL and child physical health outcomes
Parents with Low Health Literacy:
(Jimenez et al. 2013;
Porr, Drummond, and
Richter 2006)
Gaps in Current Research
• Little research has looked at the effect
parental health literacy has on child mental
health outcomes or utilization of mental
health services
• Limited understanding of HL in AA immigrant
populations
– And its relationship to outcomes both for the
individual and child
(DeWalt & Hink, 2009)
Research Aims
• This study aims to investigate the
impact of parental health literacy on
children’s health and mental health
outcome/service utilization among Asian
American immigrant parents.
Research Questions of Interest
a) Level of health literacy in AA immigrant, Latino
immigrant, African American, and White
parents?
b) Are the health literacy levels of Asian
American immigrant parents related to their
child’s mental health service utilization?
a) Are the health literacy levels of Asian
American immigrant parents related to their
children’s mental health and wellbeing?
Dataset
• 2007 California Health Interview Survey
(CHIS)
• Cross-sectional telephone survey of the non-
institutionalized population in California
• Collected data from households that had at
least one parent and one minor child
• Administered in five languages
• Oversampled AA
Dependent Variables
• Mental health service utilization
• “During the past 12 months, did (CHILD) receive any
psychological or emotional counseling?”
• “During the past 12 months did you think you needed
help for emotional or mental health problems, such as
feeling sad, anxious or nervous? “ (Teen)
• Depressive Symptoms
• Seven-item scale (Goodman, Meltzer, & Bailey, 1998) on
a 3-point Likert Scale ranging from not true (1) to
certainly true (3) (Child)
• Six-item emotional functioning scale on a 5-point Likert
Scale ranging from All (1) to None (5) (Adolescent)
Independent Variables • Parental Health Literacy
– “When you read the instructions on your prescription
bottle, would you say it is very easy (1), somewhat
easy (2), somewhat difficult (3), or very difficult (4) to
understand?”
– “When you get your written information at a doctor’s
office, would you say that it is very easy (1),
somewhat easy (2), somewhat difficult (3), or very
difficult (4) to understand?”
• Spearman Brown Correlation is .66
Control Variables
• Parents: age, gender, whether they live
in a rural or urban area, income, English
proficiency
• Children: age, gender, current asthma
status, ADHD (child only), insurance,
dental insurance, general health status
Data Analysis
• Univariate analyses: levels of HL and
utilization
• Multiple regression analyses:
relationship between the parental HL
and child outcomes, and between
parental HL and child utilization
Results: Participants - Parents
• 18 – 84 years, M = 40.76, SD = 9.11
• Latino (N = 1,195), Asian (N = 722), African
American (N = 368), White (N = 4,772)
• 3,511 Men, 5,888 Women
• 7,638 in Urban areas, 1,761 in Rural areas
Results: Participants -
Children
• 4-11 years of age
• 5,161 boys, 4,752 girls
• 9,474 insured, 439 without insurance
Results: Participants -
Adolescents
• Adolescents: 12-17 years old
• 1,823 boys, 1,815 girls
• 3,434 insured, 204 without insurance
Results: Parental Health
Literacy LevelsNon-Latino
Whites
Latino
Immigrants
Asian
Immigrants
African
Americans
Mean 4.55 4.09* 4.21* 4.53
Standard
Deviation
.61 .84 .87` .65
b (weighted,
ref = white)
-.46 -.34 -.02
t-statistic -20.76 -12.22 -.47
p-value < .001 < .001 .64
Health Literacy Levels by
Race/Ethnicity
0
1
2
3
4
5
Non-LatinoWhites
LatinoImmigrants
AsianImmigrants
AfricanAmericans
Mean
HL
Level
Results: Utilization
• Parental health literacy did not predict
mental health service utilization in any
groups.
Results: Health Outcome
• Parental health literacy significantly
predicts:
– Health outcome in Asian American
children only
Results: Mental Health
Outcome
• Parental health literacy significantly
predicts:
– Mental health outcome in Asian American
children only
B SE
Parent Age .004 .082
Parent Gender .051 .057
Household Income <.001 .126
HL Mean .038 .026*
Urban/Rural Location -.039 .514
Child Gender -.079 .003*
Child Age .001 .817
Child General Health (1) .605 .001*
ADHD -.380 <.001*
Current Asthma .062 .184
Insurance -.017 .813
Dental Insurance -.052 .191
Parental health literacy and Children Mental Health: Asian American
Conclusions/Discussion
• HL did not predict mental health outcomes for
all groups
– Suggests that HL may be a barrier to poor mental
outcomes for a certain ethnic group
– Although HL may be low in immigrant populations,
it may be a barrier only for certain groups
Conclusions/Discussion
• Contrary to expectations, HL was not
significant for teen utilization or outcomes. May be explained by:
– Teens have more control of their health decisions
than children
– Teens do not realize when they are suffering from
poor mental health
Limitations
• Health Literacy Construct
– Although previous research has suggested that the
two item HL scale is a good representation of HL
(The Commonwealth Fund, 2015 ), the scale had
low reliability for our sample which could have
impacted results
• Were not able to look at sub-Asian or sub-
Latino groups
• Were not able to look at non-Asian or Latino
immigrants
Implications for Practitioners
Study results suggests poor health literacy:
– may be associated with lower health and mental
health outcomes for their children among Asian
American parents
Practitioners need to recognize poor health
literacy & devise ways to increase health literacy
among their clients!
Health Literacy Screening
1-Item Question:
Q. How confident are you filling out
medical forms by yourself?
(extremely, quite a bit, somewhat, a little bit, not at all)
Variety health literacy screening tools available
for different populations – most commonly used:
(Chew et al., 2008)
*Predict Low Health Literacy – Veterans populations
Q1. When you read
the instructions on
your prescription
bottle, would you say
it is:
Q2: When you get
your written
information at a
doctor’s office,
would you say that it
is:
Health Literacy Screening
(Very easy, Somewhat easy, somewhat difficult, or very
difficult to understand)
2-Item Questionnaire:
2007 California Health Information Survey (CHIS)
3-Item Questionnaire:
How difficult is it for you to:
• Get advice or information about health or medical
topics if you needed it?
• Understand information that doctors, nurses and
other health professionals tell you?
• Understand written health information?
Health Literacy Screening
(Very easy, Somewhat easy, Somewhat difficult, Very difficult,
I do not know)
2016 CDC Behavioral Risk Factor Surveilliance System
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