Access to care in Asian Americans: Assessing determinants of usual source of care

Chang, Eva

Abstract

As one of the most diverse and the fastest growing minority population in the United States, understanding the resources and barriers that impact the health and health behaviors of Asian Americans is increasingly prioritized in the national health agenda. Persistent inequities in access to care highlight the need for systematic assessment of the intricate factors influencing health, especially those related to acculturation, or the long-term psychosocial and cultural effects of immigration. Having a usual source of care is an especially important measure of equity in access because of its associations with better health outcomes and utilization with preventative and primary care services. However, the little empirical research conducted on how key resources and barriers contribute to access to care for Asian Americans lacks clarity. Findings have been largely inconsistent and often do not account for unique patterns in access to care among Asian American subgroups. The broad research goals of this study to determine whether the determinants of usual source of care differs for Asian Americans, specifically, how acculturation and other predisposing and enabling resources impact usual source of care, and whether Asian American ethnicity influences the relationships of these factors on usual source of care.
Two specific Aims align with the broad research goals.
Specific Aim 1 seeks assess how the direct and indirect associations of acculturation and key predisposing and enabling resources affects the likelihood of having a usual source of care in Asian American adults compared to non-Hispanic white adults.
Specific Aim 2 seeks to examine usual source of care by Asian American ethnic subgroups (Chinese, Japanese, Korean, Filipino, South Asian, and Vietnamese) and to assess the interrelationships among acculturation, predisposing and enabling resources, and usual source of care for two important AA groups with distinct migration histories, Chinese and Vietnamese Americans. This study will fill the critical gaps in literature on the measurement and determinants of usual source of care among Asian Americans and Asian subgroups. This study will use both multivariate logistic regression and path analysis to more clearly specify how acculturation directly and indirectly influences enabling resources and having a usual source of care among Asian Americans. Findings from this study can facilitate the development of targeted interventions to promote effective health seeking behavior for underserved Asian American groups. This study draws on the California Health Interview Survey, a rich, representative, statewide, cross- sectional dataset that provides adequate sample size for Asian subgroups and detailed Asian ethnicity and demographic information that is necessary to understand the resources and barriers that Asian Americans face when accessing care. By examining Asian Americans, this study highlights differences and determinants of access to care for Asian Americans compared to non-Hispanic whites. By examining Asian American subgroups, this study highlights the heterogeneity inherent in the Asian American population. Better understanding of how immigration and acculturation impacts access to care will help policy and decision makers and community workers target attention and scarce resources to most effectively reduce inequalities in access to care.

Public Health Relevance

This proposed study will address an important health equity issue among Asian Americans and Asian American subgroups. This study will broaden the understanding of variations and underlying mechanisms of access to care by assessing key determinants (individual- and community-level acculturation, and predisposing and enabling resources) among Asian American adults. This study is expected to generate new knowledge to support policymakers, providers, and community workers in better targeting their activities to improve access to care for the understudied and underserved Asian American population.