A Systemized Review of Cultural Determinants of Health for Asian, Pacific Islander, and Desi Americans

Background: By 2055, Asian, Pacific Islander, and Desi Americans (APIDAs) are projected to be the largest immigrant group, yet remain most understudied when examining disparities related to risk factors for chronic illness. Typical risk factors for chronic illness include smoking, obesity, high blood pressure, physical inactivity, and diabetes. APIDAs are known to have higher risks for cardiometabolic diseases at a lower body mass index than other racial groups. Research highlights that South Asians have high prevalence and risk for cardiovascular disease, however major risk factors such as obesity, smoking, and physical inactivity are less common within APIDA populations. Also, breast cancer risk among APIDA women varies by nativity status meaning time spent in the U.S. accounts for breast cancer risk factors. The Hmong population in Southern California, experience the highest prevalence of metabolic risk factors such as diabetes, however the disparity is understudied therefore root causes are unknown. Overall, the distribution of these risk factors vary by race and ethnicity making prevention and intervention elusive. Moreover, culture is considered a broader determinant of health since it dictates how health issues are identified and defined, as well as how solutions are sought. The aim of this systemized review is to identify cultural determinants of health (CDOH) for APIDAs, and to examine the relationship between CDOH and chronic illness.

Methods: This systemized review examines peer-reviewed literature and followed a five-step methodological process outlined in Arksey and O’Malley (2005) and Levac and colleagues (2010): 1) identifying the research questions; 2) identifying the relevant studies; 3) selecting the studies; 4) charting the data; and 5) summarizing and reporting the results.

In the first stage, two primary research questions guided the systematized review: How are cultural drivers, mechanisms and/or determinants defined in health disparities research for APIDAs? And what role do CDOH play in health outcomes for the APIDA population as it relates to risk factors for chronic illness? Searches were carried out in the PubMed and Web of Science databases.

Results: Our initial search strategy yielded 450 records. After deduplication, 330 records were independently screened by three reviewers using a predetermined codebook. Based on eligibility criteria, 33 studies were included for analysis. Data extracted from studies included sample size, participants’ demographics, method, cultural factors, and health outcomes. The most prominent cultural drivers of health that emerged from the literature include acculturation, language, religion/spirituality, and food preference. Secondary themes included narratives about country of origin, reasons for migration, and history of colonialism.

Conclusions and Implications: There is a growing movement in social work to adopt and develop culturally responsive approaches to address health disparities. Research shows that when culturally responsive care is provided, patients respond better including increased compliance and engagement. However, research on CDOH for APIDAs remains understudied. Subsequently, culturally responsive prevention and intervention efforts remain scarce. Our work incrementally adds to this vital knowledge base by identifying cultural drivers and their roles in maintaining APIDA health. Ultimately, our work informs the development of culturally-embedded approaches for APIDAs.