Health Literacy and Chinese Americans

Subject: Public Health
Pages: 20
Words: 5693
Reading time:
21 min
Study level: PhD


Chinese-Americans represent a unique cultural group in the USA with unique traditions and values, world views, and attitudes towards health and healthcare. By far, most health-related activities are carried out by the individual and family members in the privacy of their home. How successful these practices are, to a large extent, determines the individual’s need for using professional health care services. Therefore, these personal health practices, which are largely the responsibility of the individual, determine the costs of the health care system.

The so-called “lifestyle diseases,” which account for such a high proportion of the total health care budget, are the result of personal activities over which the professional health care system has traditionally had little influence. These lifestyle diseases are the result of inadequate self-care and the use of alternative medicine so popular among Chinese-Americans and other ethnical groups. Different cultural and age groups have different health literacy and attitudes towards health and health care, the importance of disease prevention, and effective communication with medical staff. Theoretical literature and research studies show that Chinese-Americans are influenced greatly by strong cultural traditions and values transmitted from generation to generation and determining their attitudes towards health and self-care.

Chinese Americans and Culture

Speaking about healthcare and its perception by an ethnic group like Chinese-Americans, researchers (Tong 2000; Sun et al 2007) underline the importance of culture and cultural traditions. In the book, Chinese-Americans Tong (2000) proposes a deep analysis of cultural factors and traditions typical for this cultural group. he underlines that: “Perhaps what held Chinese society together despite the pressure of internal modernization was its pervasive thought or philosophy, which undergirded religiosity. The presence of ethical terms in every area of traditional Chinese culture, including music and the arts, is an indicator of the strong influence of Chinese thought in shaping the Chinese identity” (Tong 2000, p. 11). These factors have a great impact on health literacy and attitudes towards personal care and health…

Sun et al (2007) and Ying (1995) explain that culture can be explained as the learned and shared beliefs, values, and lifeways of a designated or particular group that are generally transmitted intergenerationally and influence one’s thinking and actions. For two decades, researchers Ying (1995) and Ying and Zhang (1995) have been an advocate of the need for people to become informed about other cultures’ health care beliefs and practices. They found that ethnicity refers to the universal tendency of people to think their ways of thinking, acting, and behaving are the only right and natural ways. Tong (2000) states that ethnicity perpetuates an attitude that beliefs that differ greatly from one’s own are strange, bizarre, or unenlightened, and therefore wrong. Ethnicity interferes with appreciating diverse cultures and their accompanying beliefs and behaviors.

The research study by Tong (2000) unveils that many Chinese arrived with the perception that China has the best health care treatment methods and alternative medicine solutions. They viewed Western health care as delivering top-notch high-tech care; yet lacking because the care was reductionistic rather than holistic. Furthermore, the cost of the care was seen as being exorbitant relative to the outcome. Researchers came home looking forward to investigating the many things medical staff had yet to learn about how culture influences health care practices and perceptions. Recognition of ethnicity is necessary to develop an appreciation of diverse cultures. According to statistical results “between 1980 and 1990, the number of Japanese Americans grew by only 21 percent compared with growth rates of 104 percent for Chinese Americans, 124 percent for Korean Americans” (Dhooper, 2003, p. 62).

The large layer of literature describes relations and attitudes of Chinese American towards modern western medical practices and use of them. Hampton and Marshall (2000), Dhooper (2003), Smith and Smith (1999a), and Smith and Smith (1999b) found that for the first generation of Chinese-Americans, the decision to become American — to surrender their nationality and native culture — is an act of will that may be explained by the immigrant’s motivation for migrating. That motivation, in turn, would be expected to exert a powerful influence on how the group would assimilate. The particular needs, anxieties, and expectations of the Chinese, for example, who fled from famine contrast sharply with those of immigrants whose social uprooting was less traumatic or self-imposed. The freedom to exercise some control over one’s destiny cushions the impact of the assimilation process. Their values and cultural traditions have influenced other generations of Chinese-American and determine their health literacy and knowledge.

The second generation of Chinese-Americans still preserves connections with China and relies heavily on cultural traditions and healing practices. Smith and Smith (1999 a, b) state that the main problem for two generations was the lack of money and poor access to healthcare services. Most of them could not afford regular medical examinations and professional healthcare. In the book, Tong underlines that even today working-class Chinese-Americans cannot afford professional healthcare. “The life of the working-class Chinese typically involves exploitation in the form of no overtime pay, no vacation or sick leave, no health or occupational safety benefits, and no job security” (Tong 2000, p. 115). These were the main factors that forced the first and the second generations to use traditional medical practices at home. Following Ralston (2003) and Ma and Fleisher (2003) underline that in contrast to these generations, the third generation assimilated in America and lost its connections with the native land. Most of them have received American education and have better access to medical care and regular medical examinations.

The research studies by Ma and Fleisher (2003) and Ralston et al (2003) portray that change usually creates discomfort, may even feel like punishment. Doing things differently can make one feel incompetent whereas the old ways were comfortable, so people prefer to hold onto them. Especially during the early uncomfortable stages of change, it’s helpful if people have support, early rewards, and trust that the potential gains promise to be considerably greater than any possible loss or discomfort. It is important to examine the motivations for change that may be present, or absent, in various levels of the organization. Ralston et al (2003) examine knowledge of Cervical Cancer Risk Factors and improve attitudes towards healthcare and regular medical screening among Chinese-Americans. Ma and Fleisher (2003) found that change in behavior patterns is caused by awareness of cancer information among Asian Americans and education programs.

Trust Behavior

Two-thirds of the examined literature involves trust as the main issue of health literacy and effective medical care. Following Tong, (2000) trust can be explained as a relationship of reliance and confidence. Validation invites the collaboration that is essential for successful client change. The trust developed from working together is likely to increase the accuracy and validity of the database, enriching the foundation for the rest of the nursing process. The trust growing out of mutuality provides the clients with an “anchor,” giving them the support they need to risk changing health behaviors. Collaboration ensures the benefits of two heads working on a health problem; this is essential because nursing cannot exist in a vacuum. Medical institutions cannot strive for excellence without including the full participation of the client. The client contracts for services with a qualified health care provider.

Lin et al (2005), Paschal et al (2004), Babbar (2006) found that this relationship is a negotiated partnership in which the client implicitly agrees to comply with the plan they generate together. Not all health care customers think of themselves as active, responsible partners in their care. Some do what health care professionals tell them, living out the definition of the label “patient.” The passive nature of this role creates an imbalance between the power of the nurse and the client. The passivity of this stance creates an inequitable relationship between nurses and others. As nurses, medical professionals can help reverse this apathy and listlessness by encouraging Chinese-American clients to be partners in their own health care.

This means appreciating the worth of clients and calling on their strengths. Critics (Babbar, 2006) and Hampton and Marshall (2000) underline that it is important to transform nursing care into a mutual problem-solving process when medical staff invite, even request, the full participation of partners, the clients. In their research studies Lin et al (2005), Paschal et al (2004), Babbar (2006) underline that lack of trust and reliance towards medical care are the main factors typical for the first and second generation of Chinese-Americans. Lin et al (2005) state that: “previous studies have shown that fear and mistrust, inappropriate exclusion criteria, trial design, general access to care, costs associated with language appropriate services, shortage of ethnic minority trial coordinators, consent issues, and socio-cultural barriers, e.g. language, socio-economic status, cultural beliefs, are the major barriers to ethnic minority participation in clinical trials” (p. 461).

Researchers admit that lack of knowledge and poor language skills are the main factors of mistrust and low health literacy among Chinese-Americans. Ying and Zhang (1995), Ying (1995), and Wang et al (2007) found that culturally, Chinese-Americans rely on alternative medicine rather than western medical practices and drugs. These researchers examine urban and rural populations of Chinese-Americans of the first and second generations and came to the conclusion that strong cultural bonds are the main cause of herbal-based medicine and rejection of western medical practices. similar ideas are shared by Tong (2000) who states that earlier in this century patients were more satisfied with a system of illness care that focused on disease eradication. As the influence of science and technology on health care has increased, discontent has emerged, along with resentment of chauvinistic “all-knowing,” health care professionals. Clients began demanding more influence in their health care and requesting more individualized care. Trust can be measured by response rates and feedbacks, effective communication, and increased participation of Chinese-Americans in regular medical examinations.

Trust and Medical Care

Smith and Smith (1999a,b), Ralston (2003) Paschal et al ()2004) and Mui et al (2007), Ma, and Fleisher (2003), and Jang and Woo (1998) state that if care is to be delivered in a consistent way, it must include assisting the client and family to achieve the goals that they have set up. Goals are strikingly cultural. They vary from culture to culture because of values (for example, maximizing the family versus maximizing the individual). Furthermore, nursing argues that it delivers holistic care. However, all too often, this means using only biophysical and psychosocial data. True holism must include the socio-cultural aspect as well. If nurses intend to take care of whole clients, the socio-cultural domain is essential. This is particularly true of contemporary nursing in which nurses are on the person’s turf—in the household and community. Under these circumstances, to avoid the socio-cultural is to truly miss the point of holistic care.

Ralston (2003) Paschal et al (2004) and Mui et al (2007), Ma, and Fleisher (2003) found that Chinese-Americans have high expectations for respect, knowledge, privacy, and confidentiality, and access to any information essential for adequate treatment. Nurses need to focus on the individual’s responsibility for health care along with his or her rights. It is important to emphasize what clients can do to take care of themselves, as well as to safeguard their right to quality, informed care. Similar ideas are expressed by Tong (2000) who finds that the notion of clients as consumers of health care in the 1970s has moved to the idea of clients and their families as customers. In addition to informed care, nurses must now give attention to customers’ expectations of service.

Decreased hospital stays, outpatient surgery, and the movement toward home health care makes the need for problem-solving even more essential because clients and their families and significant others play a more active role. Since clients are frequently discharged from the hospital before they are able to care for themselves, much client education and care must be done in the home. Clients need to be able to make informed decisions about their choices for insurance. Nurses need to be informed about the differences in the choice of providers and services covered by managed care providers to assist clients in the selection and in proper procedures for reimbursement. Smith and Smith (1999 a) claim that in China people trust medical institutions and doctors and have high trust and reliance. In contrast to China, in the USA Chinese are afraid of poor language skills and misunderstanding between medical staff and patients.

Smith and Smith (1999b) believe that the benefits of the collaborative client-nurse relationship (which she terms therapeutic reciprocity) go beyond any isolated meeting and contribute to growth and development for both clients and nurses. The shared meanings about clients’ experiences are a natural precursor to the shared control and responsibility for the outcomes of their relationship. Nurses and clients gain trust in each other as human beings, and in their own ability to relate effectively in the helping relationship. This discovery, although of primary value for the health care context, may transfer to other interpersonal relationships as the value of interdependence is demonstrated. Shen and Takeuchi (2001) claim that clients who take more active roles in their treatments recover faster. This benefits hospitals, which are struggling to contain the costs of health care. They reported how one American hospital instituted patient-driven health care. The goal of the hospital’s patient-centered approach is to create a caring, dignified, and empowering environment in which their clients truly direct the course of their care and call on their inner resources to speed the healing process. The staff encourages client awareness of how their own physical, mental, and spiritual resources can promote healing.

A large layer of literature discusses and analyzes participation and health education provided for the third generation of Chinese-Americans. Such authors as Babbar (2006) and Dhooper (2003), Hampton and Marshall (2000), and Jang and Woo (1998) found that through participation in a contract, clients can take personal control of their health rather than becoming passive recipients of health care directed by the provider. In the article “Health Care Needs of Foreign-Born Asian Americans” Dhooper (2003) states that as clients become more assertive about taking an active part in their health care planning, nurses will be forced to respond by renegotiating the terms of their mutual commitment. As nurses become more vocal about their contribution to health care, patients become more accountable. Whether for legal, ethical, or philosophical reasons, medical staff is likely to become much more explicit about the terms of contracts with clients in the years to come. It is important to remember that life’s problems sometimes require the healing power of time for resolution. Nurses, clients, family members, and colleagues all share in common their own humanity… this is the beauty and the challenge of the situation!.

A special in literature is paid to people’s acceptance of innovation and new treatment methods. Lin et al (2005), Paschal et al (2004), Babbar (2006) states that medical institutions can increase people’s acceptance of innovation by getting them involved in setting goals, devising strategies for achieving those goals, and determining what they will personally accept as measures of success. Changes that people feel they cannot control are the most stressful, but with the perception that they can influence the process, and with the support of others during the process, stress can be more easily managed and resistance to change reduced. The development of a steering committee, task groups, and a systems approach may seem more trouble than it’s worth. Yet more than back injury control is at stake. This literature underlines that to survive and prosper in today’s economy, companies must monitor and control all losses as well as they have always monitored profits, and worker’s compensation insurance costs are an expensive part of doing business.

Tong (2000) states that the Worker’s Compensation legislation was passed in the early 1900s to assure workers a modest income while recovering from work-related injuries. In the case of back injury, there is usually an attempt to confine the injury determinant to a trigger factor, described earlier. The Worker’s Compensation Law does not take into account the need to control underlying and complicating factors in back pain, and under the present system, no one but the employer holds a financial incentive or a central position for doing so. The law will not change until a more effective system has been demonstrated–perhaps not even then. The mandate is for better management control of the problem.

Herbal-Based Approaches

Ying and Zhang (1995), Ying (1995), and Wang et al (2007) found that the three generations of Chinese-Americans believe in herbal-based approaches and widely use them in everyday treatment and disease prevention. Traditional Chinese Medicine utilizes a highly developed body of knowledge about medicinal herbs. These herbs may be applied externally in the form of salves, or as drops and powders to be dissolved in liquids and drunk. Herbs can be cooked into a medicinal soup or dried, ground, and put into a gelatin capsule. These herbal medicines should only be prescribed by a practitioner who has been schooled in their use.

They are true medicines and have pharmacology all their own. Each herb has unique properties, side effects, and correct therapeutic values. One special herb–artemisia–is burned directly or indirectly on the acupuncture points. In their research studies, Ying and Zhang (1995), Ying (1995) underline that less than forty years ago, with the revival of Traditional Chinese Medicine in China, acupuncture was brought into modern operating rooms to control pain, during and after surgery. Western physicians learned acupuncture’s dramatic effectiveness. When there are bruises, contusions, and broken blood vessels, the acupuncturist works on dispersing this coagulated blood. some Chinese-Americans prefer to use needling techniques at precisely indicated locations and administer herbal plasters and medicines to speed up the healing process.

Snowden (2001) and Smith and Smith (1999a) explained that western medicine objectifies reality by describing and measuring living beings according to a narrow set of physically observable properties. If Western medicine cannot measure a disease by some tangible, quantifiable test, it often presumes there is no disease. Western-trained doctors do possess workable remedies, but they are not very effective in treating generalized and comprehensive maladies. This is especially true when disease states are vague and share the symptoms of a number of distinct, presumably unrelated diseases. Traditional Chinese Medicine starts from an entirely different concept of reality. At its core is a view of body energies. Experienced practitioners, using the subtle techniques in which they have been trained, can assess the status of a patient’s total energy flow. Over the centuries, Traditional Chinese Medicine has learned to tap into these energy resources in order to restore their balance. The body then has the opportunity to heal and reconstruct itself.

Traditional Chinese Medicine treats cancer by (1) enhancing the working of conventional medicine (such as drugs and radiation) in the elimination of tumors, (2) ameliorating the side effects of these conventional techniques, and (3) supporting the person throughout the treatment process and restoring health after it. Herbal medicines are the only cure for common cold and viral flu infections. If used at the very earliest signs of these common ailments, or used preventatively after exposure to pathogens but before symptoms appear, acupuncture and herbs work 99 percent of the time to abort the attack. After the flu or cold begins, either acupuncture or herbs can shorten the length of illness. In more severe cases, when a cold or flu lingers, producing a heavy cough, sinus infection, and fever, acupuncture still helps. It can alleviate an ailment that has become deeply entrenched in the body. If a person suffers every winter with bronchitis, chest problems, or asthma, or if he’s experiences allergies each spring, then a short series of treatments just before the season will elevate the immune system and may prevent recurring ailments (Smith and Smith 1999 a,b).

Health Literacy

Researchers admit that health literacy is one of the most important issues which help to maintain effective healthcare practices and motivate citizens to be active participants in healthcare.

Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Many factors affect individuals’ ability to comprehend, and in turn use or act on, health information and communication” (Understanding and Promoting Health Literacy 829).

Lifestyle behaviors remain that continue to generate more health problems than the burgeoning health care system can handle. Shen and Takeuchi (2001) and Ralston et al (2003) involve analysis and description of health literacy in their studies. They state that there are simply not enough health care professionals to treat these lifestyle diseases once they occur. More health care professionals and more expensive treatments in the traditional medical model are not the answer. Prevention of disease is the strategic choice for the future. Health education programs in the workplace represent a promising approach to disease prevention. There are benefits for both the Chinese-American employee and the employer, and, because of these benefits, the workplace provides an ideal opportunity for launching and sustaining the necessary lifestyle changes. The current burden of responsibility for health care remains largely and solely with the individual and the family–the very source of the problem. Researchers admit that:

Individuals and families both must be able to 1) communicate with health professionals; 2) understand the health information in mass communication; 3) understand how to use health-related print, audiovisual, graphic, and electronic materials; 4) understand basic health concepts (e.g., that many health problems can be prevented or minimized) and vocabulary (e.g., about the body, diseases, medical treatments, etc.); and 5) connect this health-related knowledge to health decision making and action taking” (Understanding and Promoting Health Literacy 829).

Ralston et al (2003) state that the behaviors that are targets of health education programs are very personal and sensitive ones: exercise, eating, smoking, use of alcohol and drugs (both prescribed and nonprescribed), stress management, safety practices, interpersonal relations, and even certain sexual practices. At the best of times, attempts to alter behavior patterns meet with resistance, from both conscious and unconscious sources. Sarfaty et al (2005) underline that behavioral habits in these particular areas are, therefore, not easily changed. For example, many of these behaviors offer immediate gratification, but in the long run, are extremely unhealthy. Bottling up one’s feelings may avoid an unpleasant confrontation with a colleague or family member.

These researchers came to the conclusion that if culture is broadly defined to include characteristics of organizations and if those characteristics are heavily weighted with structural and policy matters, healthcare professionals may tend to note only minimally that culture resides in people and that, whatever the intended change (in structure, policy, or whatever), the compatibility of the change with people values and beliefs needs to be taken into account. Also, Chinese-Americans may not heavily engage themselves with the basic conditions for modification of values. Therefore, the Chinese-Americans must make whatever adjustments in values, beliefs, customs, behaviors, and so on are required to get in step and to cope with the requirements of the ever-new circumstances. If there are difficulties of adjustment, explanations will enable them to see the light and act accordingly. Or, having observed that in some social changes attitudes did indeed come around after the fact, people may go ahead and make the change with the expectation that the employees will perforce adapt their cultural and ethical values.

Trust and Healthcare Literacy

Tong (2000) and Sun et al (2007), (Smith and Smith 1999 a,b), Ying and Zhang (1995), Ying (1995) found that a level of trust determines healthcare literacy and desire of Chinese-Americans to participate in healthcare and have regular medical examinations. These research studies have shown that there is a positive correlation between respect, warmth, empathy, and successful treatment outcomes in psychotherapy clients. Indirect evidence supports the notion that respect, in terms of access to the desired physician, provision of convenient clinics, and reduced waiting times for appointments, has a beneficial influence on client compliance with the therapeutic regimen. Nurses want to collect enough information from their clients to accurately assess their concerns and develop the best nursing care plan for treating their health problems. When clients feel accepted, their trust will allow them to open up and provide the information necessary to accurately assess their situation. Having sufficient data to make a correct nursing diagnosis is the first and most important step in the systematic problem-solving approach to nursing care. Whether clients’ problems are physical, emotional, or a combination, empathy can be used to acquire sufficient and comprehensive data. Tong (2000) states that:

Some Chinese believe that mental illness is caused by spiritual unrest, hereditary weakness, or metaphysical factors such as fate or weakness of character, which means that the remedies cannot be found within the realm of science or psychology. Finally, a few who do not trust or are suspicious of Euro-American mental health professionals may choose alternative forms of treatment ranging from herbalists to visits to the Chinese temple” (p. 185).

Following Ying and Zhang (1995), Ying (1995), and Wang et al (2007), trust can be shown at all stages of the problem-solving process. When developing a plan of care, it is essential to determine how Chinese-American clients feel about the proposed treatment schedule and to empathically reflect understanding. Acknowledging clients’ reactions to treatment regimes, and where possible, adjusting plans accordingly, are likely to increase compliance behavior. This response negates Chinese-American client’s fear and belittles her anxieties about this unknown procedure. It is unlikely that this response would make client feel that a nurse accepts her feelings seriously.

This empathic opening acknowledges fears about the test, and the accompanying offer demonstrates a nurses’ desire to help alleviate fears. It is likely that Chinese-Americans will be relieved by this nonjudgmental acceptance of feelings. Trust makes it safe for Chinese-Americans to believe in treatment. Whereas a judgmental response closes lines of communication, an empathic reply opens them. The purpose of a therapeutic self-disclosure is to let Chinese-American clients know that they have been understood. Self-disclosure augments an empathic reply and deepens the trust. When nurses wish to increase their level of understanding and strengthen that trust, and they feel comfortable revealing the content of self-disclosure, then self-disclosure would be the right choice.

Shen and Takeuchi (2001) underline that Chinese-American clients and families come to healthcare fearfully in their darkest hours, in the face of their own mortality or, at the time of childbirth, in the face of the wonder of creation. To have the ability to stay connected to the experience of another, a patient must pay attention to nurturing his own spirit. The article discusses that altering such health-compromising behaviors requires even more effective reinforcers. These behavior patterns are likely to be altered only if individuals feel change is in their own best interest. Relevant and accurate information concerning the consequences of change, is, therefore, important. Also critical is the individuals’ sense of self-control, of making the decision to change of their own volition. Chinese-Americans tend to be self-motivated when they feel they have the necessary competencies and that they are responsible for using these competencies.

Ralston (2003) and Ma and Fleisher (2003) prove that a value system that respects the individual is perhaps the single most important element of a successful health education program. In such an environment Chinese-Americans believe there is genuine concern for their well-being and that they will not be exploited by the company. The presence of this value system creates certain expectations among patients as well. Reciprocity is a basic form of social exchange. Being treated well by a hospital leads most patients to treat the medical institutions well — to take their responsibilities seriously, to respect policies, procedures, and properties, and, in short, to be productive. Chinese-Americans who feel respected also tend to develop feelings of loyalty to the medical institutions and respect for management.

Health Literacy in other Ethnical and Racial Groups in America

Following research studies and data collected by Snowden (2001) and Sarfaty et al (2005), Pollak et al (2002), and Paschal et al (2004) it is evident that other ethnic and racial groups have low health literacy in comparison with the third generation of Chinese-Americans. They do not deny or dismiss the effects of material reality–parasites, viruses, bacterias. The combination of the two medical systems has been more effective than either treatment working alone. Nowhere is this more apparent than in the treatment of cancer. Both medical traditions agree that cancer is the abnormal multiplication of diseased cells. Snowden (2001) explains and analyzes health literacy examining the rate of participation and involvement of African-Americans in social activities. He found that:

“African American women were more likely than White women to report attending meetings of churches and community groups, but otherwise were less socially involved than White women. African-American social involvement is more selective than previously believed and generalizations must be qualified on the basis of gender” (p. 519).

This perspective, however, deals only with the surface of the disease. Such researchers as Sarfaty et al (2005) continue looking for the “root” of cancer’s cause in a predisposition to cancer. The root of cancer lies in the body’s inability to maintain its natural balance. Lack of medical examinations and regular screening causes high rates of chronic disease among Latino populations. many ethnic minorities believe that alternative medicine including acupuncture and herbal medicine takes effect more gradually and cumulatively. It brings about changes at a very deep, energetic level. But these changes require more time than a patient in acute, immediate crisis can spare. So, Western medical techniques may help to put an abrupt end to the disease process, and acupuncture and herbal medicine can support the person before, during, and after conventional treatment. Similar results were obtained by Pollak et al (2002) who found that among African-Americans: ‘the association of having a chronic illness, age, education, not smoking menthol cigarettes and having a regular health care provider with being advised to quit smoking was tested in a multivariate logistic regression model. All 2-way interaction terms were tested, and none were found to be significant” (p. 381).

Snowden (2001) and Sarfaty et al (2005), Pollak et al (2002), and Paschal et al (2004 agree that cognitive support helps these ethnical groups think intelligently about their health, decide how to approach problems, discover the how and why of doing things a certain way, and provides some criteria for doing work. Affective support is a good feeling that accompanies open, direct communication with colleagues. The reassurance that teammates will consider a point of view and the comfort of freely expressing opinions augments positive feelings about work. Physical support is concrete assistance given by people, computers, equipment, or spatial arrangements of the environment, all of which make nursing more streamlined. The nursing literature abounds with articles related to cognitive and affective support for nurses in the workplace. Staffing requirements, an essential aspect of physical support, are discussed in the abundance of articles on retention. In this era, it is believed that the provision of adequate cognitive and affective support will attract nurses. The requirements for supplies, equipment, and environmental conveniences have likely been secured in most nursing workplaces through the efforts of technology, computerization, and stringent occupational hazard and safety regulations.

Health Literacy in Ethnical Populations (Chinese- and Asian-Americans)

In comparison with other ethnic groups, health literacy among the third generation of Chinese-Americans is high. Still, first and second generations of Chinese-Americans do not have regular medical screening and consultations. Lin et al (2005) empathize gender differences in health literacy and regular medical examinations. In their research, authors found that: “looking at disaggregated data for Asian American women and cancer screening, relatively well-educated, insured (greater than 50% with some college education and 80% with health insurance) Chinese American women had statistically significant lower rates of cervical and breast cancer screening compared with whites and certain other Asian ethnic groups” (p. 451).

According to Ma and Fleisher (2003), in the changing health care, climate the Chinese are beginning to understand that clients have a choice of providers of care. The ability to communicate clearly and with compassion, to meet and even exceed Chinese-American clients’ expectations, is the essence of customer service. Many complaints are not about clinical issues but about perceived rudeness or lack of caring. The goal of health care cost containment is to reduce or stabilize health care expenditures. Reasonably, this has become an important short-term goal of many organizations. This is clearly attested to by the enormous growth of health care cost containment consulting companies with their computer programming and tracking systems. Health care cost containment committees are finding that techniques such as increasing deductibles, establishing preferred provider organizations, health maintenance organizations, second opinions, and extensive claim reviews are effective in reducing the immediate health care cost increases. How effective these become in the long term is not yet known. Health care promotion programs can help reduce the trend toward ever-increasing health benefit costs, absenteeism, and decreased productivity.


Current literature and research studies show that low health literacy is still a problem for the majority of Chinese-Americans. The first and second generations of Chinese-Americans prefer to use alternative medicine and methods of treatment afraid of the western medical system and lack of language skills which prevents them from communicating with medical staff. More and more evidence is accumulating that healthier people and more productive people are one and the same. Although causality cannot yet be established, a clear relationship between these two factors is apparent. Being treated well makes Chinese-Americans feel well and has a direct impact on their health. In fact, survey data indicate that one of the most important factors influencing longevity is trust. In contrast to other ethnic groups, Chinese-Americans have better health literacy thus many of them avoid regular screening and medical examinations. Literature unveils that the third generation of Chinese-Americans has high rates of medical examination and low rates of chronic illnesses because of good language skills and better access to medical services. Cultural values and traditions, trust, and positive attitude towards western medicine have a direct impact on health literacy and health knowledge among Chinese-Americans.


Babbar, R.K. (2006). Bone Health of Immigrant Chinese Women Living in New York City. Journal of Community Health, 31 (1), 7.

Dhooper, S.S. (2003). Health Care Needs of Foreign-Born Asian Americans: An Overview. Health and Social Work, 28 (1), 62.

Hampton, N.Z., Marshall, A. (2000). Culture, Gender, Self-Efficacy, and Life Satisfaction: A Comparison between Americans and Chinese People with Spinal Cord Injuries. The Journal of Rehabilitation, 66 (3), 21.

Jang, M., Woo, K. (1998). Income, Language, and Citizenship Status: Factors Affecting the Health Care Access and Utilization of Chinese Americans. Health and Social Work, 23 (2), 136.

Lin, J. S., Finlay, A., Tu, A., Gany, F. M. (2005). Understanding Immigrant Chinese Americans’ Participation in Cancer Screening and Clinical Trials. Journal of Community Health, 30 (5), 451.

Ma, G.X., Fleisher, L. (2003). Awareness of Cancer Information among Asian Americans. Journal of Community Health, 28 (2), 115.

Mui, A.C., Kang, S.-Y., Kang, D., Domanski, M. D. (2007). English Language Proficiency and Health-Related Quality of Life among Chinese and Korean Immigrant Elders. Health and Social Work, 32 (2), 119.

Paschal, A.M., Lewi,n R.K., Martin, A., Dennis-Shipp, D. (2004). Baseline Assessment of the Health Status and Health Behaviors of African Americans Participating in the Activities-for-Life Program: A Community-Based Health Intervention Program. Journal of Community Health, 29 (4), 305.

Pollak, K.I,, et al (2002). Reported Cessation Advice Given to African Americans by Health Care Providers in a Community Health Clinic. Journal of Community Health, 27 (6) 381.

Ralston, J.D., Taylor, V. M., Yasui, Y., Kuniyuki, A. Jackson, C. Tu, S.-F. (2003). Knowledge of Cervical Cancer Risk Factors among Chinese Immigrants in Seattle. Journal of Community Health, 28 (1), 41.

Sarfaty, M. Turner, Ch. H., Damotta, E. (2005). Use of a Patient Assistant to Facilitate Medical Visits for Latino Patients with Low Health Literacy. Journal of Community Health, 30 (4), 299-301.

Shen, B.-J., Takeuchi, D. T. (2001). A Structural Model of Acculturation and Mental Health Status among Chinese Americans [1]. American Journal of Community Psychology, 29 (3), 387.

Snowden, L. R. (2001). Social Embeddedness and Psychological Well-Being among African Americans and Whites. American Journal of Community Psychology, 29 (4), 519-520.

Smith, D.H., Smith, S.J. (1999). Evaluating Chinese Hospice Care. Health Communication, 11 (3), 223-236.

Smith, D.H., Smith, S.J. (1999).Chinese Elders’ Communication About Medicine. Health Communication, 11 (2), 237-245.

Sun, A., Stearman, S., Chow, E.A. (2007). Accessing Cultural Competent Health Education Programs in the Twenty-First Century. Chinese America: History and Perspectives, p. 75.

Tong, B. The Chinese Americans. Greenwood Press, 2000.

Understanding and Promoting Health Literacy (2004). Environmental Health Perspectives, 112 (14), 829.

Wang, M., Mccart, A., Turnbull, A.P. (2007). Implementing Positive Behavior Support with Chinese American Families: Enhancing Cultural Competence. Journal of Positive Behavior Interventions, 9 (1), 38.

Ying, Y.-W. (1995). Cultural Orientation and Psychological Well-Being in Chinese Americans. American Journal of Community Psychology, 23 (6), 893.

Ying, Y-W., Zhang, X. (1995). Mental Health in Rural and Urban Chinese Families: The Role of Intergenerational Personality Discrepancy and Family Solidarity. Journal of Comparative Family Studies, 26 (2), 233.