The Patient: Patient-Centered Outcomes Research, Sep 1, 2012
Preliminary studies have revealed an association between cultural competence and an improvement i... more Preliminary studies have revealed an association between cultural competence and an improvement in the quality of healthcare services, increased patient satisfaction, and increased effectiveness of services. This study examined factors that helped to explain patients' perceptions of their providers' interpersonal sensitivity - one component of cultural competence. The respondents were 2075 racially/ethnically diverse adults, aged 50 years and older, who responded to a national telephone survey. Results indicate that one of the main factors predicting interpersonal sensitivity is self-rated physical health: those who reported better health were more likely to see their provider as exhibiting higher levels of sensitivity. This was true for Hispanic/Latino patients. The results also suggest that having a provider of the same race/ethnicity was a significant factor only for Hispanic/Latino patients. Despite findings from previous research, racial/ethnic concordance may not be universally effective in improving interpersonal sensitivity in healthcare settings for all racial/ethnic groups.
OBJECTIVES To examine associations among perceived racial discrimination, ethnic resources, and m... more OBJECTIVES To examine associations among perceived racial discrimination, ethnic resources, and mental distress in older Korean Americans. Ethnic resources included ethnic identity (how closely individuals identify themselves with other members of the same ethnic background) and sense of community (individuals' feelings of belonging to their ethnic group). We examined the direct effect of perceived racial discrimination and these ethnic resources, as well as their interactions, hypothesizing that mental distress associated with perceived racial discrimination would be reduced by ethnic resources. DESIGN Using survey data from the Study of Older Korean Americans (N = 2,150), linear regression models of mental distress were examined for direct and interactive roles of perceived racial discrimination and ethnic resources. RESULTS Mental distress was directly associated with perceived racial discrimination (B = 1.90, SE = .20, p < .001), ethnic identity (B = -.41, SE = .13, p < .01), and sense of community (B = -.45, SE = .12, p < .001). Perceived racial discrimination interacted significantly with sense of community (B = -1.86, SE = .28, p < .001). Subgroup analyses suggested that in the context of experiencing racial discrimination, a high sense of community can serve as a buffer against mental distress. CONCLUSIONS Ethnic resources are a benefit in coping with experiences of discrimination. The moderating role of sense of community suggests the value of fostering social capital in ethnic communities to protect and promote older immigrants' mental health.
Abstract Objectives To investigate the relationship between cognitive performance and cognitive h... more Abstract Objectives To investigate the relationship between cognitive performance and cognitive health appraisals across non-Hispanic White, non-Hispanic Black, and Hispanic older adults in the United States and to explore within-group variations by examining interactions between cognitive performance and background and health variables. Method The sample (N = 3,099) included 2,260 non-Hispanic White, 498 non-Hispanic Black, and 341 Hispanic adults aged 65 or older, from the 2016–2017 Harmonized Cognitive Assessment Protocol. Regression models of cognitive health appraisals, indicated by self-rated cognitive health, were examined in the entire sample and in racial and ethnic subgroups to test direct and interactive effects of cognitive performance, indicated by the Mini-Mental State Examination (MMSE). Results The regression model for the entire sample showed direct effects of cognitive performance and race/ethnicity on cognitive health appraisals, as well as a significant interaction between cognitive performance and being non-Hispanic Black. Cognitive performance and cognitive health appraisals were positively associated in non-Hispanic Whites but not significantly associated in non-Hispanic Blacks. Our subsequent analysis within each racial/ethnic group showed that the effect of cognitive performance in non-Hispanic Blacks and Hispanics became either reversed or nonsignificant when background and health variables were considered. Modification by age or chronic medical conditions in each racial and ethnic group was also observed. Conclusion Overall, these findings suggest that perceptions and appraisals of cognitive health vary by race and ethnicity and hold implications for how these differences should be considered in research and practice with diverse groups of older adults.
The study explored determinants of depressive symptoms among 297 Hispanic older adults living in ... more The study explored determinants of depressive symptoms among 297 Hispanic older adults living in public housing ( Mage = 76.0, SD = 7.74). Following a basic stress model, the focus was on the effects of demographic variables, risk factors (functional disability, self-perceived health, and acculturation), and social resources (network of relatives and network of friends). Hierarchical regression analyses revealed that financial status, which was a significant predictor in the initial model, became non-significant when risk factors were taken into consideration. All three risk factors were found to be significant; depressive symptoms were predicted by greater levels of functional disability, more negative self-perceived health, and lower levels of acculturation. In the final model, networks of both relatives and friends were shown to be significant even after we controlled for the effects of demographics and risk factors. Findings discussed in the article were made in the context of culture and residential setting.
OBJECTIVES The present study examined the factors associated with social isolation in Asian Ameri... more OBJECTIVES The present study examined the factors associated with social isolation in Asian Americans. Three types of social isolation (social isolation from family, social isolation from friends, and overall social isolation), identified by the Lubben Social Network Scale-6, were examined with a sample of Asian Americans representing diverse ethnic groups (Chinese, Asian Indian, Korean, Vietnamese, Filipino, and other Asians) and a broad age range (18-98). DESIGN Using data from the 2015 Asian American Quality of Life Survey (N = 2609), logistic regression models examined how each type of social isolation was predicted by sociodemographic (age, gender, ethnic origin, marital status, education, and perceived financial status), health-related (chronic medical conditions and self-rated health), and immigration-related (proportion of life in the United States and English proficiency) variables. RESULTS The percentage of the sample that fell into the category of social isolation from family, social isolation from friends, and overall isolation ranged from 18.2% to 19.3%. At 36% in the friend category and 33% in the overall category, the Vietnamese sample showed a heightened risk of social isolation. Regression analyses indicated that, for both family and friend categories, individuals who were in the middle-aged group (40-59 years old) and who had limited English proficiency demonstrated higher odds of being isolated. Reflecting relational differences in family and friend networks, the risk associated with unmarried status was specific to social isolation from family, whereas having unmet financial needs was only associated with social isolation from friends. CONCLUSIONS The study findings expand our understanding of the multiple domains of social isolation in an understudied population and emphasize the importance of developing prevention and intervention programs to foster social connectedness among Asian Americans. Our findings on risk factors and ethnic variations help identify the groups to be prioritized in intervention efforts and suggest ways to approach them.
Community Dentistry and Oral Epidemiology, May 2, 2019
Objectives:Based on Andersen’s health care utilization model, the present study examined factors ... more Objectives:Based on Andersen’s health care utilization model, the present study examined factors associated with dental service use in older Korean Americans. Focus was on predisposing characteristics (age, gender, marital status, education, and region), oral health needs (problems with teeth or gums and self-rated oral health), and enabling factors (dental health insurance, length of stay in the U.S., acculturation, and family network).Methods:Using data from surveys with Korean Americans aged 60 or older (N = 2,128), a Poisson regression model examined predictors of dental visit in the past 12 months.Findings:More than 21% of the sample reported having a problem with teeth or gums, and over half rated their oral health as either fair or poor. Approximately 71% lacked dental health insurance. The number of dental visits in the past 12 months averaged 1.40 (SD = 1.74), with about 38% having no dental visits at all. Multivariate analyses showed that higher levels of education, the presence of a problem with teeth or gums, dental health insurance coverage, longer length of stay in the U.S., and larger family networks were associated with 1.01 to 1.35 times higher number of dental visits.Conclusion:The findings not only confirmed the critical role of dental health insurance as a service enabler but also highlighted the importance of considering older ethnic immigrants’ oral health and dental care from the perspectives of culture and family.
Objectives: The objective is to examine how older Korean Americans’ perceived burdensomeness to t... more Objectives: The objective is to examine how older Korean Americans’ perceived burdensomeness to their healthcare partners is associated with the characteristics of older adult participants ( egos) and their healthcare partners ( alters). Methods:Surveys of 2150 participants in the Study of Older Korean Americans provided ego data. Participants were also asked to list up to three individuals whom they usually asked for help on health-related matters or healthcare use, which generated 3402 alters. Multilevel modeling was conducted to examine the role of the characteristics of egos and alters, as well as their cross-level interactions. Results: Perceived burdensomeness was negatively associated with English-speaking ability and residence in a low Korean density area. Perceived burden was also lowered when emotional support was received from the alters, and this pattern was pronounced among those with multi-comorbidity. Discussion: By identifying older immigrants prone to the sense of b...
The Patient: Patient-Centered Outcomes Research, Sep 1, 2012
Preliminary studies have revealed an association between cultural competence and an improvement i... more Preliminary studies have revealed an association between cultural competence and an improvement in the quality of healthcare services, increased patient satisfaction, and increased effectiveness of services. This study examined factors that helped to explain patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; perceptions of their providers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; interpersonal sensitivity - one component of cultural competence. The respondents were 2075 racially/ethnically diverse adults, aged 50 years and older, who responded to a national telephone survey. Results indicate that one of the main factors predicting interpersonal sensitivity is self-rated physical health: those who reported better health were more likely to see their provider as exhibiting higher levels of sensitivity. This was true for Hispanic/Latino patients. The results also suggest that having a provider of the same race/ethnicity was a significant factor only for Hispanic/Latino patients. Despite findings from previous research, racial/ethnic concordance may not be universally effective in improving interpersonal sensitivity in healthcare settings for all racial/ethnic groups.
OBJECTIVES To examine associations among perceived racial discrimination, ethnic resources, and m... more OBJECTIVES To examine associations among perceived racial discrimination, ethnic resources, and mental distress in older Korean Americans. Ethnic resources included ethnic identity (how closely individuals identify themselves with other members of the same ethnic background) and sense of community (individuals' feelings of belonging to their ethnic group). We examined the direct effect of perceived racial discrimination and these ethnic resources, as well as their interactions, hypothesizing that mental distress associated with perceived racial discrimination would be reduced by ethnic resources. DESIGN Using survey data from the Study of Older Korean Americans (N = 2,150), linear regression models of mental distress were examined for direct and interactive roles of perceived racial discrimination and ethnic resources. RESULTS Mental distress was directly associated with perceived racial discrimination (B = 1.90, SE = .20, p < .001), ethnic identity (B = -.41, SE = .13, p < .01), and sense of community (B = -.45, SE = .12, p < .001). Perceived racial discrimination interacted significantly with sense of community (B = -1.86, SE = .28, p < .001). Subgroup analyses suggested that in the context of experiencing racial discrimination, a high sense of community can serve as a buffer against mental distress. CONCLUSIONS Ethnic resources are a benefit in coping with experiences of discrimination. The moderating role of sense of community suggests the value of fostering social capital in ethnic communities to protect and promote older immigrants' mental health.
Abstract Objectives To investigate the relationship between cognitive performance and cognitive h... more Abstract Objectives To investigate the relationship between cognitive performance and cognitive health appraisals across non-Hispanic White, non-Hispanic Black, and Hispanic older adults in the United States and to explore within-group variations by examining interactions between cognitive performance and background and health variables. Method The sample (N = 3,099) included 2,260 non-Hispanic White, 498 non-Hispanic Black, and 341 Hispanic adults aged 65 or older, from the 2016–2017 Harmonized Cognitive Assessment Protocol. Regression models of cognitive health appraisals, indicated by self-rated cognitive health, were examined in the entire sample and in racial and ethnic subgroups to test direct and interactive effects of cognitive performance, indicated by the Mini-Mental State Examination (MMSE). Results The regression model for the entire sample showed direct effects of cognitive performance and race/ethnicity on cognitive health appraisals, as well as a significant interaction between cognitive performance and being non-Hispanic Black. Cognitive performance and cognitive health appraisals were positively associated in non-Hispanic Whites but not significantly associated in non-Hispanic Blacks. Our subsequent analysis within each racial/ethnic group showed that the effect of cognitive performance in non-Hispanic Blacks and Hispanics became either reversed or nonsignificant when background and health variables were considered. Modification by age or chronic medical conditions in each racial and ethnic group was also observed. Conclusion Overall, these findings suggest that perceptions and appraisals of cognitive health vary by race and ethnicity and hold implications for how these differences should be considered in research and practice with diverse groups of older adults.
The study explored determinants of depressive symptoms among 297 Hispanic older adults living in ... more The study explored determinants of depressive symptoms among 297 Hispanic older adults living in public housing ( Mage = 76.0, SD = 7.74). Following a basic stress model, the focus was on the effects of demographic variables, risk factors (functional disability, self-perceived health, and acculturation), and social resources (network of relatives and network of friends). Hierarchical regression analyses revealed that financial status, which was a significant predictor in the initial model, became non-significant when risk factors were taken into consideration. All three risk factors were found to be significant; depressive symptoms were predicted by greater levels of functional disability, more negative self-perceived health, and lower levels of acculturation. In the final model, networks of both relatives and friends were shown to be significant even after we controlled for the effects of demographics and risk factors. Findings discussed in the article were made in the context of culture and residential setting.
OBJECTIVES The present study examined the factors associated with social isolation in Asian Ameri... more OBJECTIVES The present study examined the factors associated with social isolation in Asian Americans. Three types of social isolation (social isolation from family, social isolation from friends, and overall social isolation), identified by the Lubben Social Network Scale-6, were examined with a sample of Asian Americans representing diverse ethnic groups (Chinese, Asian Indian, Korean, Vietnamese, Filipino, and other Asians) and a broad age range (18-98). DESIGN Using data from the 2015 Asian American Quality of Life Survey (N = 2609), logistic regression models examined how each type of social isolation was predicted by sociodemographic (age, gender, ethnic origin, marital status, education, and perceived financial status), health-related (chronic medical conditions and self-rated health), and immigration-related (proportion of life in the United States and English proficiency) variables. RESULTS The percentage of the sample that fell into the category of social isolation from family, social isolation from friends, and overall isolation ranged from 18.2% to 19.3%. At 36% in the friend category and 33% in the overall category, the Vietnamese sample showed a heightened risk of social isolation. Regression analyses indicated that, for both family and friend categories, individuals who were in the middle-aged group (40-59 years old) and who had limited English proficiency demonstrated higher odds of being isolated. Reflecting relational differences in family and friend networks, the risk associated with unmarried status was specific to social isolation from family, whereas having unmet financial needs was only associated with social isolation from friends. CONCLUSIONS The study findings expand our understanding of the multiple domains of social isolation in an understudied population and emphasize the importance of developing prevention and intervention programs to foster social connectedness among Asian Americans. Our findings on risk factors and ethnic variations help identify the groups to be prioritized in intervention efforts and suggest ways to approach them.
Community Dentistry and Oral Epidemiology, May 2, 2019
Objectives:Based on Andersen’s health care utilization model, the present study examined factors ... more Objectives:Based on Andersen’s health care utilization model, the present study examined factors associated with dental service use in older Korean Americans. Focus was on predisposing characteristics (age, gender, marital status, education, and region), oral health needs (problems with teeth or gums and self-rated oral health), and enabling factors (dental health insurance, length of stay in the U.S., acculturation, and family network).Methods:Using data from surveys with Korean Americans aged 60 or older (N = 2,128), a Poisson regression model examined predictors of dental visit in the past 12 months.Findings:More than 21% of the sample reported having a problem with teeth or gums, and over half rated their oral health as either fair or poor. Approximately 71% lacked dental health insurance. The number of dental visits in the past 12 months averaged 1.40 (SD = 1.74), with about 38% having no dental visits at all. Multivariate analyses showed that higher levels of education, the presence of a problem with teeth or gums, dental health insurance coverage, longer length of stay in the U.S., and larger family networks were associated with 1.01 to 1.35 times higher number of dental visits.Conclusion:The findings not only confirmed the critical role of dental health insurance as a service enabler but also highlighted the importance of considering older ethnic immigrants’ oral health and dental care from the perspectives of culture and family.
Objectives: The objective is to examine how older Korean Americans’ perceived burdensomeness to t... more Objectives: The objective is to examine how older Korean Americans’ perceived burdensomeness to their healthcare partners is associated with the characteristics of older adult participants ( egos) and their healthcare partners ( alters). Methods:Surveys of 2150 participants in the Study of Older Korean Americans provided ego data. Participants were also asked to list up to three individuals whom they usually asked for help on health-related matters or healthcare use, which generated 3402 alters. Multilevel modeling was conducted to examine the role of the characteristics of egos and alters, as well as their cross-level interactions. Results: Perceived burdensomeness was negatively associated with English-speaking ability and residence in a low Korean density area. Perceived burden was also lowered when emotional support was received from the alters, and this pattern was pronounced among those with multi-comorbidity. Discussion: By identifying older immigrants prone to the sense of b...
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Papers by David Chiriboga