Pathway to Cancer Literacy Among Korean American Immigrants: The Mediating Role of Family Support and Health Care Motivation

Background and Purpose. Poor cancer literacy is associated with poor adherence to recommended cancer screening practice, advanced stages of cancer diagnosis, and increased hospitalization due to lack of understanding of treatment procedures. Cancer literacy is therefore critical in individuals' ability to understand cancer screening guidelines and cancer risk factors and to navigate the health care system. Low cancer literacy is specifically observed among immigrant populations with low economic and educational status. However, research investigating what factors are associated with cancer literacy among immigrant populations is sparse. To address this knowledge gap, this study investigates predictors of and pathways to cancer literacy among underserved Korean American immigrants.

Methods. A total of 407 Korean American immigrants residing in New York City were surveyed using a quota sampling strategy. Participants were 202 females and 205 males and age ranged from 21 to 92 (mean=57.2). About 60% of the participants were married, 19% were single, and 21% were divorced or separated. The average years in the U.S. were 17.7 and it ranged from 3 months to 45 years. Over two thirds of the participants (69%) had health care insurance. Stein et al.'s 12-item cancer risk statements were employed to measure cancer literacy. Structural equation modeling was used to test a proposed conceptual model using Mplus 4.21.

Results. The final model indicates that Korean immigrants' family support was significantly but indirectly related to cancer literacy. Higher levels of social support were positively associated with higher health care motivation (beta = .35, p < .01), which was, in turn, positively associated with higher cancer literacy levels (beta = .20, p < .05). It is noteworthy that older participants were more likely to have higher levels of family support (beta = .12, p < .05) and health care motivation (beta = .13, p < .05) than their younger counterparts. Immigrants who had a family history of cancer were also found to receive more support from their family (beta = .17, p < .05). Regarding total effects, health care motivation and family support were found to be the most influential predictors of cancer literacy (total effect = .20, p < .05; total effect = .07, p < .05, respectively).

Conclusions and Implications. The findings revealed the important role of family support in cancer literacy among the Korean American immigrant population. Particularly high levels of family support were found among those who had a familial history of cancer. It is likely that those who do not have cancer in their family may be less knowledgeable than their counterparts. Interventions that aim to increase cancer literacy among immigrant populations should therefore pay particular attention to those who do not have cancer history in their family. Interventions should include multiple family members, which in turn increases health care motivation, and thereby increases cancer literacy. Such educational and intervention programs should be culturally informed and competent, with special attention placed on reducing cancer health disparity among immigrant populations.