The Changing Face of Immigration: A Gendered Perspective
Literature in the area of immigrant health research has largely overlooked the gendered pattern of immigration when more than half of the total immigrant population are women. Theories of immigrant health to an extent are still gender-blind contributing to the gaps in our understanding of the process and persistence of change in immigrant health. It is crucial to identify gender as a key social determinant, mainly because the interplay of gender with other determinants of health such as social and economic factors creates different experiences for men and women. Since the most important indicator of healthcare control is the level of healthcare utilization where socio-cultural and economic constraints often converge to restrict levels of healthcare utilization, the purpose of our study is to examine whether the effect of select variables (length of stay, social cohesion, and language efficacy) on healthcare utilization depends on gender roles as males or females. We hypothesize that (1) increased length of stay is related to increased use of utilization of healthcare; (2) Social cohesion and language efficacy will mediate the relationship between length of stay and the utilization of healthcare; (3) the relationship mediated by social support and language skills are moderated by gender roles.
Methods
Using the data from the 2009 California Health Interview Survey, this study examines the gendered pattern of healthcare utilization among immigrants in California (N=11,481). The sample included 4,614 male and 6,867 female participants. We used factor analysis to construct and validate the measures for social cohesion and language efficacy and hierarchical multiple regression to examine the degrees of relationships between the variables. We also employed a moderated mediation framework by Preacher, Rucker, and Hayes (2007) to test for mediated moderation relationships between select variables and healthcare utilization using Process Macro.
Results
Through the application of a moderated mediation framework by Preacher, Rucker, and Hayes (2007), the study shows that social cohesion and English language efficacy mediate the moderated relationship of gender and length of stay on healthcare utilization. Bootstrap results (10,000 resamples) with a boostrapped 95% confidence interval (CI) around the indirect effect containing 0, confirmed full mediation effect. Direct effect of social cohesion (Beta=-.0692,p<.001) and language efficacy (Beta=-.0009, p=.8818) on healthcare utilization showed partial and full mediation effects respectively. The results of the moderated mediation analysis for the mediating role of social cohesion and language efficacy showed a statistically significant interaction (Beta= -.5241, p<.001) suggesting that the effects of select variables on healthcare utilization is moderated by gender roles.
Implications for social work research and policy
These findings contribute to the evolving literature on gendered pattern of immigration and the expanding discourse of the immigrant paradox. This study provides implications in the application of an intersectional perspective to health equity efforts. Studies on gendered patterns of immigration on healthcare utilization can help build knowledge on the unique predictors and needs of this population and also create a conceptual and empirical framework to disaggregate the concept of “immigrant health” accounting for diversity and differences within this broad categorization.