Limited English Proficiency, Health, and Healthcare among Older Immigrants

有限的英语能力（LEP）是老年移民的一个独特的脆弱性，对健康和医疗保健构成重大风险。鉴于社会和环境背景在LEP患者的生活中起着关键作用，本申请研究了社会联系和邻里/社区特征（例如，种族密度、社区卫生服务环境）影响LEP与健康/保健之间的联系。我们把韩裔美国老人作为目标群体。我们的选择是基于这样一个事实，即他们是一个迅速扩大的LEP群体的成员（即，韩语在美国LEP人群使用的语言中排名第四。他们在健康和医疗保健方面表现出明显的差异。该项目旨在探索社会联系和邻里特征的直接和互动作用（1）在LEP和健康之间的关系和（2）在LEP和医疗保健之间的关系。当个人缺乏社会联系和/或当他们生活在缺乏面向种族的资源和服务的地区时，LEP对健康/医疗保健的负面影响预计会更大。该项目采用了社会网络分析和地理信息系统的创新和协同组合。为了捕捉人口的异质性，我们将使用3个联合收割机代表韩裔美国人人口密度的连续体：纽约（高）、德克萨斯州（中等）和佛罗里达（低）。在与社区咨询委员会进行重点小组讨论之后，将对族裔社区进行直接评估。在每个地点，将编制一份面向族裔的服务（包括保健服务）总清单， 所标识的服务将被地理编码。随后，将使用概率抽样程序对900名韩裔美国人（每个研究中心年龄为65岁，300人）进行调查。除了传统的调查措施，名称生成器的方法将用于探索参与者的社会网络成员和医疗保健的地方。使用SNA，来自名称生成器的信息（人和地点的名称和地址）将被编入索引，以代表（1）社会联系和（2）与社区卫生服务的参与。利用地理信息系统，调查数据将与一个文件相连接，该文件将2010年人口普查和直接社区评估得出的地区资源图结合在一起。合并后的档案将包括诸如朝鲜人在社区和一般以及面向民族的地区卫生服务中所占比例等变量。多层次模型（MLM）将被用来探讨研究问题和假设。研究结果不仅将增强我们对LEP脆弱性机制的理解，还将确定可用于健康规划和干预的个人和社区因素（包括人和地方）。总体方法和研究结果将为如何制定有效的干预措施提供信息，以减少语言障碍，并确保各种LEP人群获得适当的卫生服务。

DESCRIPTION (provided by applicant): Limited English proficiency (LEP) is a unique vulnerability of older immigrants that poses a significant risk to health and healthcare. Given tha social and environmental contexts play a critical role in the lives of persons with LEP, this application investigates how social connectedness and neighborhood/community characteristics (e.g., ethnic density, health service environments in the neighborhood) influence the link between LEP and health/healthcare. We used Korean American elders as the target group. Our selection was based on the fact that they are members of a rapidly expanding LEP population (i.e., Korean is ranked 4th in the languages spoken by LEP individuals in the U.S.) and that they manifest marked disparities in health and healthcare. The project aims to explore the direct and interactive roles of social connectedness and neighborhood characteristics (1) in the relation between LEP and health and (2) in the relation between LEP and healthcare. The negative impact of LEP on health/healthcare is expected to be greater when individuals lack social connections and/or when they live in areas lack ethnically oriented resources and services. The project employs an innovative and synergistic mix of Social Network Analysis (SNA) and Geographic Information Systems (GIS). To capture the heterogeneity of the population, we will use 3 sites that combine to represent a continuum of Korean American population density: New York (high), Texas (intermediate) and Florida (low). Following focus groups with Community Advisory Boards, direct assessments of ethnic communities will be conducted. At each site, a master list of ethnically oriented services (including health services) will be generated, and each identified service will be geo-coded. Subsequently, 900 Korean Americans (aged e 65, 300 at each site) will be surveyed using a probability sampling procedure. In addition to the traditional survey measures, name-generator approaches will be used to explore participants' social network members and places for healthcare. Using SNA, information from the name generators (names and addresses of people and places) will be indexed to represent (1) social connectedness and (2) engagement with health services at the community. Using GIS, the survey data will be linked to a file combining the 2010 Census and the area resource map derived from the direct community assessment. The combined file will include variables such as proportions of Koreans in the neighborhood and general as well as ethnically-oriented area health services. Multi-Level Models (MLM) will be used to explore the research questions and hypotheses. The results will not only enhance our understanding of the mechanisms underlying LEP vulnerability but also identify individual- and community-level factors (both in people and places) that could be used in health planning and interventions. The overall approach and findings will inform how to develop effective interventions to reduce language barriers and ensure access to appropriate health services for diverse LEP populations.