(WITHDRAWN) Chinese Americans' Priorities and Practices for Designating a Health Care Proxy

Background and purpose: Many Americans, especially older adults, need decision-making from someone else due to cognitive impairment. Americans are legally protected to appoint a health care proxy (HCP) -- someone they trust to make health care decisions for them if they lose the ability to make decisions. Chinese comprise the largest Asian group in the U.S.; their health beliefs and practices have been influenced by both western and eastern cultures, yet few studies have investigated Chinese Americans’ HCP designation rates and influencing factors. The purpose of the study was to examine factors associated with Chinese Americans’ HCP designation using Andersen’s Behavioral Model as a lens.

Methods: Data were from the 2015 Asian American Quality of Life Survey conducted in Austin, TX. Hierarchical logistic regression analyses were conducted to test the incremental predictive power of predisposing factors (e.g., age, gender, marital status, education, religion), enabling factors (health insurance, acculturation, English proficiency, family support), and a needs factor (self-rated health).

Results: Among participants, only 13.8% had designated an HCP. Age, marital status, religious affiliation, health insurance, acculturation, and self-rated health were predictors for HCP designation. The odds of having an HCP designation were 1.96 times higher for those age 65 and above, compared to those age 18-64 (p=0.045); The odds were 2.40 times higher for those who were married (p=0.006); The odds were 1.79 times higher for Protestants (p=0.042) and 2.25 times higher for Buddhists (p=0.025), compared to those with no religious affiliation; Having a health insurance increased the odds of having an HCP designation by 2.23 (p=0.022); For each additional unit in acculturation score, the odds of having an HCP designation increased by 0.65 (p=0.011); Compared to those who rated their health as excellent, very good, or good, those rating health as fair or poor had a 2.97 times higher odds of HCP designation (p=0.001).

Conclusions: Various factors influence Chinese Americans’ HCP designation. Appropriate and innovative practices could be used to assist HCP discussion and designation among Chinese and other racial/ethnic immigrant populations, including but not limiting to: actively reaching out to older adults with poor health conditions while also encouraging HCP conversations to happen early in one's illness trajectory, ensuring the involvement of spouses and other family members, ensuring access to and coverage of health insurance among immigrant populations, and enhancing health promotion collaboration with churches and other community-based organizations.