Suffering Alone: Understanding Barriers to Healthcare Utilization Amongst Asian-American Women

Background and Purpose: Previous research demonstrates that Asian-American women are at high risk for health and mental health issues, including depression, suicide, substance use, and sexually transmitted infections.  However, they are less likely than their peers in the general population to seek health and mental health services.  There is limited empirical research focused on the barriers to healthcare utilization among Asian American woman.  This paper fills an important gap in the literature by providing an in depth understanding of the factors Asian American women identify as preventing them from accessing healthcare services. 

 Methods:   The qualitative interviews are part of a larger mixed methods study, the Asian-American Women’s Sexual Health Initiative Project (AWSHIP), designed to examine health behaviors amongst Chinese, Korean and Vietnamese women, aged 18-35, who are children of immigrants. Interviews were conducted with 36 participants using a semi-structured interview guide focused on gaining in depth information relating to health behaviors and healthcare utilization.  All interviews were audio recorded and transcribed verbatim.  Data was analyzed inductively using Braun and Clark’s (2006) stages of thematic analysis. The analysis focused on gaining a deeper understanding of the factors Asian American women identify as barriers to utilizing healthcare services.

Results:  Thematic analysis of the interview transcripts led to the core theme of “suffering alone,” meaning that participants felt isolated and alone when handling health and mental health concerns.  Participants identified cognitive factors, such as shame and stigma, as important issues permeating the Asian-American mentality on health care.  For example, participants emphasized the importance of “holding your head up” and being perceived as strong and competent.  Participants were confronted with the conflict between expressing their own emotional distress and the cultural stigma associated with disclosing their emotional vulnerabilities. Having a mental health issue was perceived by the Asian community as being weak and incompetent.  Participants also identified practical factors including services being perceived as unhelpful in addressing their concerns, professionals lacking a cultural understanding and the services being perceived as a waste of time and money.  Although participants did not find traditional “talk therapy” to be helpful, several benefitted from psychotropic medication, demonstrating a medicalization of mental health. 

Conclusions and Implications:  Cultural and practical reasons were identified as barriers for access to mental health care among Asian American women.  Despite the fact that all our participants are children of immigrants, whom were either born in the US or grew up in the US since childhood, shame and stigma emerged as a dominant cultural barrier.  As a practical barrier, a lack of mental health professionals who can truly understand their culturally specific needs was identified.   Efforts should be in place to reduce the shame and stigma in mental health utilization and to create culturally specific interventions that Asian American women can relate to and to utilize in order to effectively address the alarming problems of mental health and sexual health among this population.