The Effect of Social Support on Health Literacy Among Korean American Immigrant Women

Background: Asian Americans face many barriers to accessing healthcare and have higher rates of many diseases than other racial/ethnic groups. Korean Americans (KAs), in particular, have higher cancer, Hepatitis B, and depression rates of all Asian ethnic subgroups. However, KA immigrant women’s utilization of health care services, including cancer screening, is low. Lower levels of health literacy have been found to account for low rates of health care services, contributing to health disparity for this population. This study utilized Andersen’s Behavioral Model to bridge gaps of knowledge by investigating: (1) current levels of health literacy among KA immigrant women and (2) factors associated with health literacy among KA immigrant women.

Methods: A cross-sectional survey research design was used for this study. The sample was 243 KA immigrant women, aged 21 to 85 in a large Southeastern city in the U. S. A quota sampling was used to ensure approximately the same number of women in each of the following age categories: 21 to 29, 30 to 39, 40 to 49, 50 to 59, 60-69, and 70-85. This study utilized two data collection methods: (1) face-to-face interviews with the women aged ≥ 60, and (2) self-administered questionnaires with those aged ≤ 60. The dependent variable was health literacy. Independent variables were predisposing factors (age, marital status, income, and education), enabling factors (English proficiency and social support) and need factor (health status). Data analyses included descriptive analyses, bivariate analysis, and a three-step hierarchical linear regression (only predisposing and need factors for Model 1, enabling factors were added in Mode 2, and the interaction effect of enabling factors was added in Model 3).

Results: The variance of health literacy accounted for by each model increased from 9.1% to 19.2% to 21.1%. In Model 3, age (β=.230, SE=.046, p<.01), education (β=.145, SE=.136, p<.05), and health status (β=.183, SE=.090, p<.01) continued to predict health literacy significantly. The main effects of English proficiency (β=.740, SE=.368, p<.001) and social support (β=.292, SE=.088, p<.01) were significant, implying participants with better English proficiency and larger social support size have higher health literacy. For those with low English proficiency, the positive association between social support and health literacy was significantly large, while those with high English proficiency showed constant health literacy regardless of their social support size.

Conclusions: This study has several practice implications for interventions to increase health literacy among KA immigrant women. First, health-related materials and education should be developed and delivered in Korean to target KA immigrant women with limited English proficiency. Distributing the materials in places where KAs congregate, such as Korean churches, senior centers, primary care physicians’ offices, grocery stores, and hair salons could be an effective strategy. Second, considering the significant relationship between the size of social support and health literacy among KA immigrant women, psychoeducational programs in existing social groups for women (e.g., church women’s groups, alumni groups) or peer education programs may help increase health literacy among this population.