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Article Excerpt
There are abundant research findings on service barriers in older ethnocultural minority individuals. Although it is generally believed that service barriers create a negative impact on health outcomes, little research is available to examine this relationship. With the continuous increase in the immigrant population in Western countries, it is essential for practitioners and policymakers to understand the factors that facilitate better health and well-being of elderly immigrants, who are often considered one of the most vulnerable immigrant groups due to the multiple challenges they face as immigrants and older adults. In this study, we examined the relationships between service barriers and aging Chinese immigrants and their health status.
Recent research has provided evidence of the disparities in health and access to health services among ethnocultural minorities in Canada and the United States (Dunlop, Coyte, & McIsaac, 2000; Groeneveld, Laufer, & Garber, 2005; Moy, Dayton, & Clancy, 2005;Williams, 2005). Research on social determinants of health has also indicated how systemic social and economic barriers are associated with health outcomes for visible minority groups (Willems, De Maesschalck, Deveugele, Derese, & De Maeseneer, 2005), highlighting the importance of understand ing health status by incorporating nonhealth factors. Service access problems concerning minority elders include language (Talamantes, Lawler, & Espino, 1995), lack of transportation (Morgan & Sampsel, 1994;Tsai & Lopez, 1997), inadequate knowledge of services (Richardson, 1992; Tsai & Lopez), and inadequate financial resources (Damron-Rodriguez, Wallace, & Kington, 1994).
People of ethnic minority background in the Western countries face more service barriers than the general older adult population and report a lower level of use of services designed for aging adults than the general population (Woodruff, 1995). Institutional racism, mistrust of the system, inadequate knowledge of services available, lack of availability of culturally sensitive services, personal beliefs, family dynamics, and culturally dissimilar styles of interaction between service providers and users have also been reported (Biegel, Farkas,& Song, 1997; Casado & Leung, 2001; Damron-Rodriguez et al., 1994; Morgan & Sampsel, 1994;Talamantes et al., 1995; Torsch & Ma, 2000). Some researchers have noted that poor access to services affects the health and well-being of individuals (Zhan, Cloutterbuck, Keshian, & Lombardi, 1998). However, most of the studies on service barriers have been descriptive and did not report the effects of service barriers on health outcomes. Therefore, our objective in this research is to examine the relationships between access barriers and the health status of the older immigrants. The key research question is "Do access barriers significantly affect the physical and mental health status of aging immigrants in a negative manner?"
Older Chinese immigrants in Canada were researched for several reasons. First, the older Chinese belong to the largest visible minority group in Canada. With a population of more than 1.1 million, this group accounts for 25.8 percent of all visible minorities (Statistics Canada, 2003). There is very little published research on service barriers experienced by this subpopulation, particularly the elderly members. Second, the experience of older Chinese immigrants in a Western country such as Canada may be particularly challenging because of their unique worldviews, cultural values, beliefs, and languages and their tendency to be perceived as "traditional." Appreciating the implications of services barriers on their health and well-being is useful for devising better strategies to meet their needs. Third, the findings are relevant to informing policymakers and practitioners of the challenges facing aging Chinese immigrants in other Western countries, for example, the United States, Australia, and the United Kingdom, as many of their Chinese immigrants are from countries of origin that are similar to those of Canada's, such as China, Taiwan, and Hong Kong (U.S. Census Bureau, 2006). The findings can facilitate policymakers and practitioners in these Western societies to better understand the effects of service access challenges on this culturally unique elderly group.
METHOD
Research Design and Sampling
A survey research design was used for this study, which was part of a larger study on the health and well-being of aging Chinese Canadians (Lai, Tsang, Chappell, Lai, & Chau, 2003) age 55 years and older in seven Canadian cities--Victoria and Vancouver, British Columbia; Calgary and Edmonton, Alberta; Winnipeg, Manitoba; Montreal, and Toronto. The total Chinese population in these cities accounted for close to 89 percent of the Chinese population in Canada. To obtain the sample, telephone numbers listed with a Chinese surname in all of the research sites were identified to form the sampling frame. A total of 40,654 telephone numbers were randomly selected from the 297,064 numbers listed with a Chinese surname. Telephone screening was conducted by trained interviewers who called the selected telephone numbers to identify eligible participants who acknowledged themselves as an ethnic Chinese age 55 years or older. The eligible participants were then invited to a face-to-face interview either at the participant's home or at one of the local community organizations collaborating with the research team. The "rolling-a-dice" method was used to select only one participant in households with more than one eligible participant. The interviews were conducted in either English or a Chinese dialect spoken by the participant. The method of using surnames as identification keys for locating Chinese and other Asian participants has been established in...
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