Limited English Proficiency, Health, and Healthcare among Older Immigrants

描述(由申请人提供)：英语水平有限(LEP)是老年移民的一个独特弱点，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患者的生活中扮演着关键角色，该应用程序调查社会联系和邻里/社区特征(例如，种族密度、邻里卫生服务环境)如何影响LEP与健康/医疗保健之间的联系。我们以韩裔美国长辈为目标群体。我们的选择是基于这样一个事实，即他们是快速增长的LEP人群的成员(即韩语在美国LEP人群使用的语言中排名第四)。而且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(1)在轻症与健康之间的关系中和(2)在轻症与健康之间的关系中的直接和交互作用。当个人缺乏社会关系和/或生活在缺乏面向种族的资源和服务的地区时，LEP对健康/保健的负面影响预计会更大。该项目采用了社会网络分析(SNA)和地理信息系统(GIS)的创新和协同组合。为了捕捉人口的异质性，我们将使用3个地点，它们结合起来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)。在有社区咨询委员会的焦点小组之后，将对族裔社区进行直接评估。在每个地点，将生成一份面向族裔的服务(包括保健服务)的总清单，每个 识别的服务将进行地理编码。随后，将使用概率抽样程序对900名韩裔美国人(每个地点的年龄为65,300岁)进行调查。除了传统的调查方法外，还将使用姓名生成器方法来探索参与者的社交网络成员和医疗保健场所。利用SNA，来自姓名生成器的信息(人名和住址)将被编入索引，以代表(1)社会联系和(2)对社区卫生服务的参与。利用地理信息系统，调查数据将被链接到一个文件，该文件结合了2010年人口普查和直接社区评估得出的地区资源地图。合并后的文件将包括一些变量，如附近和一般地区的韩国人比例，以及以种族为导向的地区医疗服务。将使用多水平模型(MLM)来探索研究问题和假设。结果不仅将加强我们对LEP脆弱性的机制的了解，而且还将确定可用于卫生规划和干预的个人和社区层面的因素(包括人和地方)。总体方法和结果将告知如何制定有效的干预措施，以减少语言障碍，并确保不同的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.