Acculturation and health behaviors among older Chinese immigrants in the United States: A qualitative descriptive study

Filial piety and older adult caregiving among Chinese and Chinese-American families in the United States: a concept analysis

BACKGROUND

The culturally sensitive nursing practice has not embedded filial piety as a cultural value and stance pertaining to caregiving among aging Chinese and Chinese-American (CCA) families in the United States, yet it is critical for healthy aging among CCAs.

PURPOSE

To understand filial piety when caring for aging CCAs and conceptualize an operational definition and framework.

METHODS

A systematic search was conducted in CINAHL, PubMed, Scopus, and PsycINFO databases. Analysis of the concept of filial piety among CCAs used Walker and Avant's methods. Twenty-six studies were selected in the final full-text analysis.

FINDINGS

Synthesis of evidence identified four antecedents: (a) filial obligation as a 'cultural gene', (b) sense of altruism, (c) familial solidarity, and (d) societal expectation of 'birth right'. Attributes included familial material and emotional support, obedience, pious reverence, and societal norms. Consequences were related to caregiver burden, psychological and physical well-being, quality of life, and health equity.

CONCLUSION

Filial piety is an intrinsic desire to support aging parents and an extrinsic desire to adhere to Chinese societal moral tenets. The proposed operational framework "Caregiving for aging CCAs in the United States" merits further study.

Impact of English Proficiency on Health Literacy in Older Korean Immigrants: Mediating Effects of Social Support and Acculturation

Limited English proficiency (LEP) is one of the most influencing factors of personal health literacy (PHL) in the older immigrant population. Over the years, the proportion of older Korean immigrants with LEP has not improved and it is still noted as a major barrier to PHL. Therefore, organizational approaches are needed to enhance the PHL of older immigrants with LEP. This study aims to find the mediating effect of social support and acculturation between LEP and PHL by conceptualizing social support and acculturation as an organizational health literacy strategy. Data from 244 older Korean immigrants living in the states of Alabama and Georgia, USA, were used to conduct the study. Korean version of the Multidimensional Scale of Perceived Social Support (MSPSS), East Asian Acculturation Measure (EAAM), and Health Literacy Survey-12 Questionnaires (HLS-Q12) were used to measure the variables. The path analysis was conducted to find the serial mediation effects of social support and acculturation. The results showed that 77.5% of the participants reported not having fluent English proficiency. English proficiency (β =- 0.21, p = 0.007), social support (β = 0.17, p = 0.004), and acculturation (β = 0.18, p = 0.011) significantly predicted the PHL, and social support (β = 0.04, p = 0.028) and acculturation (β = 0.14, p < 0.001) mediated the relationship between LEP and PHL. Discussion: Health-related organizations and communities are encouraged to provide external social support and acculturation opportunities to enhance PHL in older Korean immigrants with LEP.

Effects of Mind-Body Qigong Exercise on Overall Health, Fatigue/Sleep, and Cognition in Older Chinese Immigrants in the US: An Intervention Study with Control

Background

Culturally relevant exercises may help improve health and address disparities faced by older immigrants due to language and cultural barriers. Few studies have focused on such exercise interventions among older Chinese immigrants at US daycare centers.

Methods

We conducted a 10-week nonrandomized controlled trial in older Chinese immigrants in Philadelphia, US. The intervention group practiced Chinese Qigong (Baduanjin) 5 days a week guided by trained research assistants and video instructions. The control group maintained their usual daily activities. We collected self-report assessments on overall health, sleep, and fatigue and implemented two computerized cognitive tests measuring psychomotor vigilance task (PVT) and memory twice, preintervention and postintervention. Repeated measures general linear model (GLM) and paired samples t-tests were used for data analyses.

Results

Eighty-eight older adults (Qigong, n = 53; control, n = 35) with an average age of 78.13 (SD = 5.05) were included. Groups showed no significant differences at baseline evaluation. After the 10-week exercise, the intervention group showed significant improvements in overall health (p=0.032), fatigue (p < 0.001), and cognitive functions including memory (p=0.01), response speed (p=0.002), and response time (p=0.012) on the PVT, as well as marginally significant benefits in sleep (p=0.058). Between-group comparisons identified significant group-by-time interactions in health (p=0.024), sleep (p=0.004), fatigue (p=0.004), and memory (p=0.004).

Conclusion

We revealed significant positive effects of Qigong in older Chinese immigrants across multiple health domains. Findings highlight the potential of a culturally relevant exercise in addressing health disparities.

Dietary Acculturation and Food Habit Changes among Chinese Immigrants in Portugal

Chinese individuals who immigrate to a Western country tend to change their eating patterns and behaviors depending on how long they live in the host country. This is dietary acculturation, and it can have a positive or negative impact on eating habits. Thus, we aimed to characterize the dietary acculturation of the Chinese immigrant community in Portugal and check the trend of the direction of this acculturation. The study involved 213 immigrants and assessed food consumption, meal patterns, and dietary acculturation. A mean Western acculturation score of 70.1 ± 8.9. was identified and 71.4% had a high Western acculturation score. No one had low or very high Western acculturation. Participants who have a higher level of acculturation tend to have higher energy and fat intake. The likelihood of mixing meals, including, and combining, Chinese and Portuguese meals and foods is associated with time spent in Portugal. Efforts should be made to encourage Chinese immigrants to make a positive dietary transition during their acculturation process.

Culturally tailored group Qigong exercise in older Chinese immigrants: A feasibility study

BACKGROUND

Culturally tailored group exercise bridges health disparities among new immigrants, particularly older adults. We designed a Chinese Qigong (Baduanjin) exercise intervention testing the feasibility and acceptability among older Chinese at a senior daycare center in Philadelphia, PA, US.

METHODS

10-week Qigong group in-person exercise was delivered 5 days a week, using a 12-minute video tutorial under trained research assistants' guidance. Daily attendance and attrition was recorded. Participants completed baseline self-report assessments on physical and mental health, and two computerized cognitive tests, the psychomotor vigilance test and a memory test.

RESULTS

53 older adults participated (mean age: 78, female: 88.7%). Average daily attendance was 65.28%. Stratification analysis on age groups <80 and ≥80 shows no significant differences on key variables.

CONCLUSIONS

Recruitment for Baduanjin Qigong exercise was feasible in senior daycare centers, and older adults could easily learn and safely follow exercise movements. Preliminarily findings call for further research.

An Examination of Psychological Stress, Fatigue, Sleep, and Physical Activity in Chinese Americans

Chinese Americans comprise the largest Asian subgroup in the U.S. Yet, little research has focused on the well-being of this population. This study aimed to (1) examine psycho-physiological health (psychological stress and fatigue) and lifestyle behaviors (sleep and physical activity) between Chinese Americans and whites, and (2) investigate whether race and lifestyle behaviors were independent predictors of psycho-physiological health. This study included 87 middle-aged healthy adults (41 Chinese Americans, 46 whites). Each participant underwent a two-night actigraphy-based sleep assessment. Chinese Americans reported higher psychological stress and fatigue, had poorer objective sleep outcomes (shorter sleep duration, lower sleep efficiency, and longer sleep onset), and engaged in lower physical activity levels than whites. Race and poor perceived sleep quality were independently associated with high psychological stress and fatigue. The findings warrant further exploration of social and cultural determinants of health in this minority group to reduce health disparities.

Exploration of Social Exclusion among Older Chinese Immigrants in the USA

BACKGROUND

Older adults are vulnerable to social exclusion and its detrimental health outcomes. However, few existing studies focus on the social exclusion of older adults as immigrants and ethnic-minority individuals. To fill the gap, drawing on the conceptual framework of old-age vulnerability, this study explored the multi-dimensional experience of social exclusion for older Chinese immigrants in the U.S. and investigated how old age and immigration exacerbated older adults' experiences of social exclusion.

METHOD

The study included 24 in-depth face-to-face individual interviews in Los Angeles and employed thematic analysis on the qualitative data. Themes were identified until consensus was reached among the research-team members. Triangulation of multiple analysts was used to avoid analytic bias.

FINDINGS

Findings showed that older Chinese immigrants experienced social exclusion in the following dimensions: basic services; material and financial resources; social relations and activities; socio-cultural aspects; and neighborhood/territory/community. In addition to age-related factors, immigration-related factors, including changes in physical and socio-cultural environments and legal status, also contributed to older immigrants' extra vulnerabilities to social exclusion.

CONCLUSIONS

This study provides useful information and strategies for human and healthcare service providers to find ways to overcome social exclusion and enhance older Chinese immigrants' social inclusion in the U.S.

Temporariness and Post-Migration Adaptation of Older Migrants: The Case of Chinese Grandparenting Migrants in Singapore

Post-migration adaptation has been a major theme in migration studies. Yet extant research has typically focused on immigrants who will presumably settle in the host society and overlooked temporary migrants, especially those who move in later life. While the former is expected to assimilate into the host society over time, temporary migrants spend limited and intermittent periods of time in the host society only. The normative frameworks of migrant adaptation are, therefore, inadequate for analyzing the experience of older temporary migrants. Drawing on ethnographic data collected from 41 Chinese grandparenting migrants in Singapore, this article uses temporariness as a central analytic lens to examine their post-migration adaption experience, including their attitudes towards their temporary presence in the host country, the constraints they encountered, and the strategies they used to cope with such experiences. We introduce the concepts of “objective temporariness” and “subjective temporariness” to illustrate how the duration of stay allowed by the host state and migrants’ feelings towards their temporary presence respectively affect migrants’ intentions and ability to adapt to the new environment. Conceptualizing temporariness as a continuum, we show how diverse forms of temporariness (transient versus extended) have differentially shaped the adaptation patterns of short-term stayers (staying one to three months each time) and long-term stayers (staying at least a year or more). Our findings underscore the importance of analyzing the temporal alongside the spatial when examining temporariness as a condition experienced by older temporary migrants and as an instrumental tool used by nation-states to regulate migrant populations.

Acculturation, Physical Activity, and Metabolic Syndrome in Asian American Adults

INTRODUCTION

Asian Americans (AsAms) have a high prevalence of metabolic syndrome (MetS) and are one of the least physically active racial groups in America. The purpose of this study was to examine the relationship between MetS and moderate-to-vigorous physical activity (MVPA) among AsAm adults and whether acculturation modifies this relationship.

METHOD

Data were from 2,259 AsAms participating in the 2011-2016 National Health and Nutrition Examination Survey. Physical activity (PA) was self-reported as minutes of weekly MVPA. Acculturation included nativity, length of residency in America, and language preference. The International Diabetes Federation criteria was used to determine the presence of MetS.

RESULTS

About 64.4% of AsAms did not meet the PA recommendation (MVPA ≥150 min/week). The prevalence of MetS was 39.2%. The odds of having MetS were greater among AsAms who did not meet MVPA recommendations compared with those who did meet MVPA recommendations (odds ratio [OR] = 1.5, 95% confidence interval [CI] = [1.11, 2.07]). When stratified by acculturation, this association remained statistically significant in the groups who immigrated to America more than 15 years ago and who spoke English only.

CONCLUSION

MVPA reduces MetS risk in AsAm adults, especially among more acculturated AsAms. Culturally adapted programs are warranted to promote PA and adequate knowledge of disease prevention in this population.

Barriers and facilitators of health among older adult immigrants in the United States: an integrative review of 20 years of literature

Background

There are over seven million older adult immigrants in the United States, and that number is expected to increase. Older adult immigrants in the United States have unique factors that influence their health.

Methods

In this integrative review, we systematically review 20 years of peer-reviewed literature on the barriers (i.e. isolation, lack of English Language Proficiency, low health literacy, lack of SES resources, discrimination) and facilitators (i.e. English Language Proficiency and maintaining ones native language, social support, culturally sensitive providers, healthcare access) of health among older adult immigrants in the United States.

Results

We found differing uses of the term ‘older adult’, emphasis on the lack of homogeneity among older adult immigrants, social support and isolation as significant barriers and facilitators of older adult immigrant health, and inconsistencies in uses and definitions of acculturation. We also examined relevant theories in the literature. Based on the literature review, focusing on Acculturation Theory, Social Cognitive Theory, and Successful Aging Theory, combining these three theories with findings from the literature to create the Older Adult Immigrant Adapted Model for Health Promotion.

Conclusions

Public health strives to promote health and prevent adverse health outcomes. Our integrative review not only systematically and thoroughly explicates 20 years of literature, but the Older Adult Immigrant Adapted Model for Health Promotion, provides guidance for future research and interventions.

Exploring the Determinants of Food Choice in Chinese Mainlanders and Chinese Immigrants: A Systematic Review

Determinants of food choice in Chinese populations have not been systematically synthesised using a cultural lens. This study reviewed qualitative studies exploring food choice determinants of both Chinese mainlanders and Chinese immigrants living in Western countries. Ovid Medline, CINAHL Plus, Web of Science, ProQuest, and China National Knowledge Infrastructure database (CNKI) were searched from database inception to 1 April 2021. Studies were included if they involved qualitative research methods, were written in English or Chinese, investigated the factors influencing food choices, and targeted Chinese mainlanders or Chinese immigrants living in Western countries. Twenty-five studies (24 in English, 1 in Chinese) were included, involving 2048 participants. Four themes were identified; (1) the principles of traditional Chinese medicine (TCM), (2) perceptions of a healthy diet in Chinese culture (e.g., regular eating, eating in moderation, and emphasis on food freshness), (3) the desire to maintain harmony in families/communities, and (4) physical/social environmental factors all significantly influenced Chinese people's food choices. It is important to acknowledge these factors when developing culturally appropriate nutrition programs for promoting health in Chinese mainlanders and Chinese immigrants.

What Matters Most to Older Chinese Adults

Introduction:

Although an abundance of gerontological research has focused on subjective well-being, quality of life, and life satisfaction, we know little about what matters most to older adults in sub-cultural groups. The purpose of this study was to explore what matters to older Chinese adults.

Methods:

The study used a qualitative interpretive design, drawing influences from phenomenology and constructed meaning through participants’ lived experiences.

Results:

After data analysis, a core theme of cultural foundations and categorical themes emerged. This study emphasized the importance of hearing the voices of Chinese older adults and how they viewed well-being, quality of life, life satisfaction, and health care.

Discussion:

The findings of this study have added to the body of existing knowledge of what matters most to older adults. These insights may advance nursing as it pertains to culturally congruent health care.

Acculturation, Health Behaviors, and Social Relations among Chinese Immigrants Living in Spain

This study aims to identify acculturation experiences about social relations and health behaviors of first-generation Chinese immigrants in the South of Spain, including food patterns, physical exercise, and tobacco and alcohol use. A phenomenological qualitative study was conducted using semi-structured interviews, informal conversations, and field notes. All data were analyzed under the Berry’s Model of Acculturation. A total of 133 Chinese immigrants were included. Our findings show that separation was the dominant acculturation strategy, followed by integration and assimilation, while marginalization was not present in this immigrant population. Most of the immigrant population maintains a link to the customs of their home country, favoring the process of identity and collective self-esteem. These results can help health managers and the government to further understand Chinese immigrants in Europe and to establish appropriate health interventions to this group.

Acculturation Mitigates the Negative Impact of Perceived Stress on Depressive Symptoms Among U.S. Chinese Older Adults

The present study aimed to examine the role of acculturation in mitigating the negative impact of perceived stress on depressive symptoms among U.S. Chinese older adults. Data of 3,159 Chinese adults over 60 years old were drawn from the Population Study of Chinese Elderly in Chicago (PINE). In addition to socio-demographic variables, participants' acculturation levels, perceived stress, and depressive symptoms were assessed. Perceived stress was positively related to depressive symptoms among Chinese older adults. However, no significant association was found between acculturation level and depressive symptoms. Regression analysis supported the moderation hypothesis of acculturation level on the relationship between perceived stress on depressive symptoms. The negative impact of perceived stress on depressive symptoms was mitigated for Chinese older adults who had higher levels of acculturation than for those who had lower levels of acculturation. The findings have implications in minority aging and mental health policies during the on-going pandemic era.