The Role of Self-Rated Mental and Physical Health in Utilizing Healthcare Services Among Korean Americans

Background: Korean Americans (KAs) are among the fastest-growing Asian ethnic groups in the United States. Research indicates that KAs have notably high rate of depressive symptoms, ranging from 33.3% to 45%, which is nearly double the national average (18.5%) (Bernstein et al., 2021; Kim et al., 2015). The high prevalence of depressive symptoms underscores a critical need for people to utilize healthcare services, but despite the apparent need, KAs exhibit low utilization rates of mental health services. Existing research has consistently suggested that such disparity can be attributed to sociocultural factors, including language barriers, lack of culturally and linguistically appropriate services, and a strong preference for informal support systems over professional help (Jang et al., 2008). However, very few studies have explored personal factors, including self-awareness and evaluation of one’s well-being as a mediating step between symptom recognition and healthcare utilization. This gap in the literature suggests a need for a more nuanced understanding of how personal perceptions and evaluations could act as mediators in the healthcare utilization, thereby challenging the existing focus predominantly on external barriers. Hence, this study aimed to investigate the roles of self-rated physical health (SRPH) and self-rated mental health (SRMH) in healthcare utilization among Korean Americans using the Health Action Process Approach Model (HAPA). Methods: The survey, conducted in New York City and New Jersey between January and May 2018, used a non-probability convenience sampling method and included 689 (290 male, 399 female, M=54.39, SD=18.99) KA participants aged 18 and older. Depression was measured using the Center for Epidemiologic Depression Scale-Korean Version (CESD-K) consisting of 20 items (M=0.78, SD=0.47). Self-rated mental health and self-rated physical health were measured using single-item questions on a scale of 1 (Terrible) to 4 (Excellent). Healthcare service utilization was measured by asking participants to enter a number of visits to primary care physicians and mental health specialists. Control variables included gender, years in the U.S., and marital status. Hayes’s PROCESS macro was used to examine a parallel multiple mediator model with 5,000 bootstraps. Results: Findings showed that depressive symptoms were not associated with healthcare utilization. Both self-rated mental health ( =.069, p < .001) and self-rated physical health ( = .040, p < .01) were statistically significant mediators between depressive symptoms and healthcare utilization. The difference in the effect size between self-rated mental health and self-rated physical health was .029, with self-rated mental health appearing to be larger. However, the effect sizes of the two mediators were not statistically different. Implications: Our findings suggest that symptom recognition is not sufficient to activate help seeking behaviors but rather efforts should be prioritized to increase self-awareness and self-assessment of physical and mental health status as a point of intervention with KA adults. Additionally, as Health Action Process Approach Model suggests, an awareness of health issues is necessary before using health care services, our results support that an ability of perceive one’ health is crucial for seeking treatment.