The Role of Social Networks in Health Service Utilization Among Low-Income Older Korean Immigrants

Background and Purpose: Research has shown that social networks strongly influence older adults’ health-related behaviors including health service utilization. The findings, however, are mixed, suggesting the role of social networks could vary depending on diverse characteristics of older adults and their social and cultural contexts. Low-income older adults, particularly among immigrants, are one of the most vulnerable populations with substantial health care needs. This study examined how close social networks are associated with health service utilization among low-income older Korean immigrants. In particular, we focused on types of social relations (family members/friends), modes of social contacts (in-person/remote), and ethnic diversity of close friends.

Methods: Data were collected from structured interview surveys with 113 Korean immigrants living in subsidized senior housing communities in Chicago from March to May in 2020 (mean age = 78.1±7.0, female = 74%). Health service utilization was measured by the number of doctor visits in the past two years. Frequency of social contacts were measured by 6-point-Likert scale (1 = less than once a year; 6 = Three or more times a week), respective of the types of social relations (family members not living together vs. friends) and the modes of social contacts (in-person vs. remote including phone, mail, email, text message, etc.). Ethnic diversity of close friends was measured by 5-point-Likert scale (1 = All Korean; 5 = All Americans). The frequency of use of the two modes of contacts with family members and friends, respectively, and the ethnic diversity of close friends were used to predict the number of doctor visits. Given the nature of the outcome variable as a count variable and its over-dispersed distribution, negative binomial regression model was employed for analysis.

Results: One fifth of participants reported to meet family members three or more times a week in person while 52% contacted remotely. Over a half of the participants contacted friends three or more times a week in person (54%) or remotely (51%). Most participants had ethnically homogenous groups of close friends: all Korean (79%) or mainly Korean (16%). The regression results showed that, controlling for sociodemographic, immigration-related, and health-related factors, a specific mode of social contacts with a certain type of relations was positively associated with health service use. Specifically, probability of doctor visit steadily increased as frequency of remote contacts with friends – but not in-person contacts – increased (IRR=1.12, p<.05). Neither in-person nor remote contacts with family members as well as ethnic diversity of close friends were associated with doctor visits.

Conclusion and implications: This study contributes to understanding of the role of social networks in facilitating health service utilization among low-income older immigrants, which has been understudied. We demonstrated that frequent remote social contacts with close friends matter for low-income older immigrants in using health care, which may provide informational and appraisal support more effectively compared to other types/modes of social contacts. Future studies could further explore the process of health communication and contents of the health information shared among close social network members of low-income older immigrants.