Does English Language Efficacy Affect Social Cohesion and Healthcare Utilization Among Immigrants in the US? Testing Mediation Effects

Background

 With the rising demographic shifts and increasingly diverse societies in the US, normative goals of socially cohesive societies critical for overall success, are becoming even more essential. However, preservation and maintenance of community level social cohesion has been challenging, especially among immigrant populations. While evidence suggest social cohesion to influence health through promotion and adoption of health-related behaviors, increase access, and utilization of services through psychosocial processes, it also suggest that diversity is undermining social cohesion, alienating societies towards segregation and isolation. While social cohesion is important for immigrant health, destination language seems to be a core component through which immigrant groups establish these social connections. The acquisition of destination language therefore, is a crucial channel through which the health of immigrants is affected in two ways. First, language efficacy affects access to health inputs and production such as, access to higher paying jobs and greater safety. Second, immigrant access to social network is correlated with both language proficiency and health.  The purpose of our study was to explore the role of English language efficacy on the relationship between social cohesion and healthcare utilization among immigrant groups. We hypothesized that language efficacy mediated the relationship between social cohesion and healthcare utilization among immigrants with good health and poor health.  

 

Methods

We pooled foreign born population, either naturalized citizens or non-citizens, resulting in an immigrant only dataset (N=11,134), drawn from the 2012 California Health Interview Survey. Using PROCESS Macro, we tested the mediated path of social cohesion on healthcare utilization through English language efficacy among two groups of immigrants (good health and poor health), controlling for demographic characteristics. Bootstrapping from the process analysis provided significant direct and indirect effects and their respective effect sizes.

Results

Findings from the mediation analysis supported our hypothesis. English language efficacy fully mediated the relationship between social cohesion and healthcare utilization among both immigrant groups. The direct effects of social cohesion on English efficacy (b=0.0757, p<.001) and that of language efficacy on healthcare utilization (b= 0.164, p<.001) were significant. However, the direct effect of social cohesion on healthcare utilization was not significant (b= 0.004, p>.05), further affirming the mediating role of language efficacy. Bootstrapping results from the process analysis indicated indirect effect of social cohesion on immigrant healthcare utilization to be significant for both groups.

 Conclusion

 As diversity increases, development and maintenance of social cohesion to unravel the mechanisms by which it affects utilization of healthcare among immigrant groups is crucial.  Immigrants have inadequate access to healthcare, lower rates of healthcare utilization, and they also endure discrimination and poverty further accelerating negative health effects. Given the rapid increase in the number of immigrants with lower English language efficacy, it is critical to provide health care providers and policymakers with the evidence they require to design and effectively implement linguistically accessible services. Finding ways to increase the social cohesion among diverse societies is critical to fostering a successful society, achieving equal opportunity, equity, and justice through closing these health gaps among the increasingly diverse immigrant populations.