Preventive care service usage among Chinese older adults in the Greater Chicago area

Status of the utilization of preventive care services and its associated socio-demographic factors among Iranian elderly

Introduction

The growing population of the elderly, the rising costs of medical care and the low use of preventive services are three factors that highlight the importance of using preventive health care services in the Iranian population. This study aimed to determine the status of the use of preventive care services and its associated socio-demographic factors in the elderly referred to health centers.

Methods

In this analytical cross-sectional study, a number of 160 elderly people referred to health centers in East Guilan, Iran was selected by multi-stage cluster sampling. Data were obtained from May to September, 2021 using a questionnaire containing utilization of preventive care services (9 items) and socio-demographic characteristics.

Results

The highest and the lowest utilization rates of preventive care services among study participants were related to the blood pressure test (96.9%) and colonoscopy (17.5%), respectively. Multivariate analysis showed that only income had a significant association with performing fasting blood sugar test (p = 0.004), blood lipid test (p = 0.004), and blood pressure test (p = 0.013). Also, the associations between having an underlying disease and performing fasting blood sugar test (p = 0.032) and blood pressure test (p = 0.002), the association between gender and performing the bone mineral density test (p < 0.001), and the association between occupation and performing Pap-smear test (p = 0.011), were statistically significant.

Conclusions

The utilization rates of screening tests for most cancers, including gastrointestinal cancers, were low. Since, there were a significant association between income, disease, gender and occupation with the utilization of some preventive care services, considering them in health centers' preventive care program design might be useful.

An examination of the implementation of a patient navigation program to improve breast and cervical cancer screening rates of Chinese immigrant women: a qualitative study

BACKGROUND

Chinese Americans have lower breast and cervical cancer screening rates than the national average and experience multiple barriers to cancer care. Patient navigators have improved screening and follow-up rates for medically underserved populations, yet investigations of cancer navigation programs and their implementation among Chinese Americans are limited. To address this gap, we used the Consolidated Framework for Implementation Research (CFIR) to examine facilitators and barriers to implementing the Chicago-based Chinatown Patient Navigation Program (CPNP) for breast and cervical cancer screening, follow-up, and treatment.

METHODS

Stakeholders from clinical care, supportive care services, and community organizations were invited to participate in qualitative interviews to illuminate implementation processes and stakeholder perspectives of facilitators and barriers to implementing the CPNP. Interviews were audio-recorded, transcribed, and deductively coded according to CFIR domains, including (1) intervention characteristics; (2) outer setting; (3) inner setting; and (4) the implementation process.

RESULTS

We interviewed a convenience sample of 16 stakeholders representing a range of roles in cancer care, including nurses, clinical team members, administrators, physicians, a community-based organization leader, and a CPNP navigator. Findings detail several facilitators to implementing the CPNP, including patient navigators that prepared Chinese-speaking patients for their clinic visits, interpretation services, highly accessible patient navigators, and high-quality flexible services. Barriers to program implementation included limited regular feedback provided to stakeholders regarding their program involvement. Also, early in the program's implementation there was limited awareness of the CPNP navigators' roles and responsibilities, insufficient office space for the navigators, and few Chinese language patient resource materials.

CONCLUSIONS

These findings provide valuable information on implementation of future patient navigation programs serving Chinese American and other limited-English speaking immigrant populations.

'There's nothing you can do … it's like that in Chinatown': Chinese immigrant women's perceptions of experiences in Chicago Chinatown healthcare settings

Objectives: Chinese American women living in linguistically isolated communities are among the least likely to utilize healthcare services. Qualitative research methods can help identify health system vulnerability points to improve local healthcare delivery for this population.Design: We conducted 6 focus groups among 56 Chinese-speaking adult women in Chicago's Chinatown between July and August 2014 to explore their perceptions of experiences receiving medical care and interacting with healthcare providers in Chinatown healthcare settings.Results: Health system/clinic infrastructure and patient-provider communications were perceived barriers to care at Chinatown healthcare settings. Chinese participants reported long wait times, difficulty scheduling appointments, and poor front desk customer service. Communication difficulties at Chinatown healthcare settings involved language barriers with non-Chinese-speaking providers, but consideration for healthcare providers, provider demeanor, and reliance on provider recommendation also hindered patient-provider communications.Conclusions: Findings improve understanding of barriers to care experienced by Chinese immigrant women in one urban Chinatown community.

Development and validation of a predictive index of elder self-neglect risk among a Chinese population

OBJECTIVE

To develop a predictive index that estimates the individual risk of incident self-neglect onset among the US Chinese older adults.

METHODS

The study used two waves of longitudinal data from 2713 participants of the Population Study of Chinese Elderly (PINE). Data were collected during 2011-2015 in Chicago, Illinois, with approximately 2-year follow-up intervals. The main outcomes are incident self-neglect cases. Variables in 14 potential predictive domains were considered, which are (1) sociodemographic/socioeconomic, (2) neighborhood/community, (3) immigration and acculturation, (4) adverse events, (5) culture, (6) general wellbeing, (7) health behavior, (8) medical health, (9) health care, (10) physical function, (11) cognitive function, (12) social wellbeing, (13) violence, and (14) psychological wellbeing. Stepwise selection in multivariable logistical regression models and bootstrapping were used to develop and validate the predictive index.

RESULTS

The 2-year self-neglect incidence rate was 237 (8.7%). A 19-item predictive model (with a c-statistic of 0.74) was developed. After correcting for overfitting by validating in 100 bootstrapping samples, the model demonstrated moderate predictive accuracy by a c-statistic of 0.68. A point-based risk index was developed and has an area under the receiver operating characteristic curve of 0.73.

DISCUSSION

The study developed an efficient index with a moderate-to-good predictive ability of self-neglect. With further external validation, modification, and impact studies, the index could be a culturally relevant tool for practitioners to quantify the risk of self-neglect among the US Chinese older population.

The Associations Between Sociodemographic Characteristics and Trust in Physician With Immunization Service Use in U.S. Chinese Older Adults

This study investigated sociodemographic factors for immunization care use and the relationship between trust in physician (TIP) and immunization service use in older Chinese Americans. Data were collected through the Population Study of Chinese Elderly, including survey information of 3,157 older adults in the Greater Chicago area. Regression results showed that the odds of getting vaccinated were higher for those who were older, female, and had higher education and income. After adjusting for the covariates, higher TIP was associated with greater immunization service use. The highest tertile of TIP was associated with higher odds of using immunization service (OR 2.19, 95% CI [1.76, 2.72]), especially for flu and pneumonia vaccines. Findings suggests that immunization service use may be increased by improving TIP and promoting targeted health care management plans for racial/ethnic minorities, which is highly relevant to increase the vaccination rate and contain the pandemic as the COVID-19 vaccine is available.

Adaptation and Preliminary Evaluation of a Lung Cancer Screening Decision Tool for Older Chinese American Populations

BACKGROUND

Lung cancer is a significant health issue among Chinese Americans. The study purpose was to translate and culturally adapt the Agency for Healthcare Research and Quality's (AHRQ) lung cancer screening decision tool to the needs of older Chinese American smokers.

METHODS

This study used a mixed methods approach. In the first phase, AHRQ lung cancer screening decision aid was translated from English to Chinese. The second phase consisted of a paper and pencil survey (N = 50) designed to measure knowledge and attitudes regarding lung screening. Finally, focus groups (N = 5, 27 participants) were conducted to obtain input on the translated and culturally adapted AHRQ lung cancer screening DA.

RESULTS

The mean age of participants was 70.4 years (SD = 5.4) and the majority were male (n = 42; 84%). Seventy-four percent of the sample reported being a former smoker and 26% a current smoker. Perceived risk for lung cancer was low (26%) and the majority of participants (70%) were unaware of lung cancer screening. Perceived benefits (e.g., early cancer detection) and barriers of LDCT screening (e.g., costs) were reported by participants. The qualitative findings were largely consistent with the quantitative results. Following the revisions to the translated AHRQ DA, participants reported satisfaction with the readability and information provided.

CONCLUSIONS

Lung cancer screening represents an evidence-based approach for reducing lung cancer morbidity and mortality among chronic high frequency smokers. Culturally targeting evidence-based lung cancer screening decision-aids to the language, cultural and health literacy needs of high risk populations may increase uptake of lung cancer early detection screening.

The Chinatown Patient Navigation Program: Adaptation and Implementation of Breast and Cervical Cancer Patient Navigation in Chicago's Chinatown

Background

As health care reform continues within the United States, navigators may play increasingly diverse and vital roles across the health care continuum. The growing interest in patient navigation programs for underserved populations calls for detailed descriptions of intervention components to facilitate implementation and dissemination efforts.

Methods

In Chicago's Chinatown, Chinese immigrant women face language, cultural, and access barriers in obtaining breast and cervical cancer screening and follow-up. These barriers spurred the research partnership between Northwestern University, the Chinese American Service League, Mercy Hospital & Medical Center, and Rush University Medical Center to formalize the Chinatown Patient Navigation Collaborative for adapting and implementing previously developed patient navigation models.

Results

In this report, we describe the adaptation of patient navigation to build the Chinatown Patient Navigation Collaborative's community-based patient navigation program for breast and cervical cancer. We offer insights into the roles of community patient navigators in safety net hospital and underserved Chinese immigrant communities, and describe implications for patient navigation initiatives to maximize community benefits by improving access to health care for vulnerable populations.

Conclusions

Our adaptation and implementation of a patient navigation intervention in Chicago's Chinatown illustrates promising approaches for future navigator research.

Chinese Immigrant Women's Attitudes and Beliefs About Family Involvement in Women's Health and Healthcare: A Qualitative Study in Chicago's Chinatown

Purpose: Healthcare utilization and health-seeking behaviors of Chinese American immigrant women may be influenced by longstanding cultural perspectives of family roles and relationships. An understanding of Chinese immigrant women's perceptions of family social support in health and how these beliefs manifest in healthcare utilization and help-seeking behaviors is critical to the development of culturally appropriate health interventions. Focusing on a sample of Chinese women in Chicago's Chinatown, this qualitative study seeks to describe women's attitudes and beliefs about spouse and adult children's involvement in women's health and healthcare.

Methods: We conducted six focus groups among 56 Chinese-speaking adult women in Chicago's Chinatown between July and August 2014. Focus groups were transcribed, coded, and analyzed for emergent themes.

Results: Women reported that their adult children supported their health and healthcare utilization by helping them overcome language and transportation barriers, making and supporting decisions, and providing informational and instrumental support related to diet and nutrition. Women viewed these supports with mixed expectations of filial piety, alongside preferences to limit dependency and help-seeking because of concern and emotional distress regarding burdening adult children. Women's expectations of the spouse involvement in their healthcare were low and were shaped by avoidance of family conflict.

Conclusion: Findings inform opportunities for the development of culturally appropriate interventions to enhance Chinese immigrant women's health and healthcare. These include patient navigation/community health worker programs to promote self-management of healthcare and family-centered strategies for enhancing family social support structures and reducing family conflict.

Association Between Social Engagement and Cancer Screening Utilization in a Community-Dwelling Chinese American Older Population

Objectives: This study aims to examine the association between social engagement and cancer screening utilization among a Chinese American older population. Method: Data were drawn from the Population Study of Chinese Elderly (PINE). In total, 3,157 Chinese older adults enrolled in this study. Cancer screening utilization was assessed by asking whether participants had utilized cancer screenings. Social engagement was measured with 16 questions. Results: After controlling for potential confounders, a higher level of social engagement was associated with increased utilization in blood stool test (OR 1.03, [1.02, 1.05]), colonoscopy (OR 1.02, [1.01, 1.03]), mammography (OR 1.06, [1.05, 1.08]), Pap test (OR 1.04, [1.03, 1.06]), and prostate specific antigen (PSA) test (OR 1.03, [1.01, 1.05]). Compared with those with low levels of social engagement, older adults with high levels of social engagement were more likely to have utilized a blood stool test (OR 1.85, [1.46, 2.35]), a colonoscopy (OR 1.37, [1.09, 1.72]), a mammography (OR 3.05, [2.25, 4.14]), and a Pap test (OR 1.99, [1.49, 2.66]), but not more likely to have utilized a PSA test (OR 1.40, [0.97, 2.03]). Conclusion: This study underscores the association between active social engagement and increased utilization of cancer screening among a Chinese American older population. Improving social engagement could be helpful in promoting cancer screening utilization.

Association Between Neighborhood Cohesion and Cancer Screening Utilization in Chinese American Older Adults

This study aims to examine the association between neighborhood cohesion and cancer screening utilization in a community-dwelling Chinese American older population. Data were drawn from the Population Study of Chinese Elderly including 3159 Chinese American older adults aged 60 and above in the greater Chicago area. Cancer screening utilization was assessed by asking whether participants had undergone colon, breast, cervical, or prostate cancer screening. Neighborhood cohesion was measured through six questions. Logistic regression analysis showed that greater neighborhood cohesion was associated with higher likelihood of utilizing a mammogram (OR 1.32, 95% CI 1.14-1.52), a Pap test (OR 1.22, 95% CI 1.06-1.41), but not of a blood stool test (OR 1.10, 95% CI 0.98-1.23), a colonoscopy (OR 1.05, 95% CI 0.94-1.17), and a PSA test (OR 1.13, 95% CI 0.95-1.34). This study suggests positive associations between neighborhood cohesion and breast and cervical cancer screening utilization among a Chinese American older population.

The Influence of Health Literacy and Acculturation on Cancer Screening Behaviors Among Older Chinese Americans

Objective: Andersen's Behavioral Model of Health Services Utilization was used as a framework to examine the influence of acculturation and health literacy on cancer screening behaviors among older Chinese Americans living in the greater Chicago area. Method: Data were obtained from the Population Study of Chinese Elderly in Chicago (N = 3,157; mean age = 72.8 years). Logistic regression analyses were conducted to examine the impact of acculturation and health literacy on lifetime cancer screening utilizations and adherence to cancer screening guideline established by American Cancer Society (ACS) after controlling for predisposing, enabling, and need factors of Andersen's behavioral model. Results: Lifetime rates of ever had cancer screening were low among older Chinese Americans living in the greater Chicago area. The majority of study participants were not adherent to ACS early detection cancer screening guidelines. Results from multivariate analyses showed that higher health literacy (odds ratio range = 1.39-1.72) and acculturation (odds ratio range = 1.28-2.06) levels were associated with an increased likelihood of lifetime and current cancer screening among older Chinese Americans. Discussion: The findings of this study highlight the importance of working to improve health literacy and developing effective interventions to increase cancer screening among older Chinese Americans.

Breast Cancer Screening Beliefs Among Older Chinese Women in Chicago's Chinatown

Background

Chicago's Chinatown is home to a sizeable community of first-generation Chinese American immigrants. This qualitative study seeks to describe the attitudes toward, and barriers and facilitators of, breast cancer screening among Chinese women in Chicago's Chinatown to inform strategies for future interventions.

Methods

We conducted six focus groups among Chinese-speaking adult women aged 45 and older. Focus groups were transcribed, coded, and analyzed for emergent themes.

Results

Forty-seven women participated in focus groups; 10 (21%) had received a breast cancer diagnosis in their lifetime, all participants were foreign-born, and 80% have resided in the United States for over 10 years. Participants expressed a range of breast cancer beliefs, attitudes toward screening, barriers encountered, and facilitators. Some differences were noted between women with cancer and those without. Barriers described include language, time, not wanting to burden their adult children, and transportation. Navigation services and physician recommendation were suggested facilitators to screening.

Conclusions

Our findings have important implications for development of interventions and policies to bolster breast cancer screening among Chinese women. We highlight the need to connect Chinese older adults with resources to navigate the health care system and present opportunities for community stakeholders, researchers, health professionals, and policy makers to improve the health of Chinese Americans.

Knowledge and Beliefs About Biospecimen Research Among Chinese Older Women in Chicago's Chinatown

BACKGROUND

Enhancing the participation of Chinese older women in biobanking efforts is important for precision medicine efforts, as underrepresented groups risk benefiting less than others from medical advancements in individualized therapies. Focusing on a sample of Chinese older women in Chicago's Chinatown, this qualitative study seeks to describe attitudes toward, and barriers and facilitators of, participation in biospecimen research.

METHOD

We conducted six focus groups among Chinese-speaking adult women age 45 and above. Focus groups were transcribed, coded, and analyzed for emergent themes.

RESULTS

Forty-seven women participated in focus groups, the majority (66.0%) were age 66 and over and half (50.1%) had less than a high school education. Participants expressed predominantly positive attitudes toward biospecimen research, but also identified multifaceted barriers to participation that included cultural beliefs of the body, perceived physical and privacy risks, as well as perceptions related to aging. Use of minimally invasive biospecimen collection and education to promote awareness of biospecimen research were suggested facilitators to increasing biospecimen research participation.

CONCLUSIONS

Culturally and linguistically isolated populations like Chinese older women are at risk of exclusion from advancements in precision medicine. Our findings provide cultural insights for tailoring interventions for Chinese older women to increase knowledge, change attitudes, and increase intention and participation in biospecimen research. We also highlight the need for individual, family, and community level interventions to promote healthy aging among Chinese older women.

Variations Between Sources of Social Support and Cancer Screen Behaviors in U.S. Chinese Older Adults

BACKGROUND

Social support is a key indicator of utilization of preventive health care among older adults, but we have limited knowledge on these associations in U.S. Chinese older adults. This study aims to examine the association between sources of social support and cancer screening behaviors among Chinese older adults in the greater Chicago area.

METHODS

Data were drawn from the Population Study of Chinese Elderly in Chicago. Social supports were measured by asking the frequency of receipt of support from spouse, non-spouse family members, and friends. Use of cancer screenings were evaluated by asking the history of utilization of colon, breast, cervical, and prostate cancer screenings.

RESULTS

After adjusting for covariates, results indicated significant association between higher social support and higher utilization of cancer screenings. Regarding to different sources of social support, higher levels of social supports from family members (odds ratio [OR], 1.15 [1.07, 1.25]) and friends (OR, 1.14 [1.06, 1.23]) were associated with higher utilization of breast cancer screening. However, higher levels of social support from family members (OR, 0.94 [0.88, 0.99]) and friends (OR, 0.94 [0.88, 1.00]) were associated with lower utilization of colon cancer screening. No associations were found between social support and prostate cancer screening.

CONCLUSIONS

This study provides evidence that different types of social support were associated with variations in the utilization of cancer screenings. Future longitudinal studies are needed to explore the causal relationship between social support and cancer screening use.

Determinants of cancer screening in Asian-Americans

PURPOSE

Recent data suggest that Asian-Americans (AsAs) are more likely to present with advanced disease when diagnosed with cancer. We sought to determine whether AsAs are under-utilizing recommended cancer screening.

METHODS

Cross-sectional analysis of the 2012 Behavioral Risk Factor Surveillance System comprising of AsAs and non-Hispanic White (NHW) community-dwelling individuals (English and Spanish speaking) eligible for colorectal, breast, cervical, or prostate cancer screening according to the United States Preventive Services Task Force recommendations. Age, education and income level, residence location, marital status, health insurance, regular access to healthcare provider, and screening were extracted. Complex samples logistic regression models quantified the effect of race on odds of undergoing appropriate screening. Data were analyzed in 2015.

RESULTS

Weighted samples of 63.3, 33.3, 47.9, and 30.3 million individuals eligible for colorectal, breast, cervical, and prostate cancer screening identified, respectively. In general, AsAs were more educated, more often married, had higher levels of income, and lived in urban/suburban residencies as compared to NHWs (all p < 0.05). In multivariable analyses, AsAs had lower odds of undergoing colorectal (odds ratio [OR] 0.78, 95 % confidence interval [CI] 0.63-0.96), cervical (OR 0.45, 95 % CI 0.36-0.55), and prostate cancer (OR 0.55, 95 % CI 0.39-0.78) screening and similar odds of undergoing breast cancer (OR 1.29, 95 % CI 0.92-1.82) screening as compared to NHWs.

CONCLUSIONS

AsAs are less likely to undergo appropriate screening for colorectal, cervical, and prostate cancer. Contributing reasons include limitations in healthcare access, differing cultural beliefs on cancer screening and treatment, and potential physician biases. Interventions such as increasing healthcare access and literacy may improve screening rates.