Christine M. L. Kwan

Testing the efficacy of culturally adapted coping skills training for Chinese American immigrants with type 2 diabetes using community-based participatory research.

Chinese Americans demonstrate greater prevalence of diabetes than non-Hispanic whites and find standard diabetes care disregards their cultural health beliefs. Academic researchers and Chinatown agencies collaborated to culturally adapt and test an efficacious cognitive-behavioral intervention using community-based participatory research. Using a delayed-treatment repeated-measures design, 145 adult Chinese immigrants with Type 2 diabetes completed treatment. Immediate benefits of treatment were evident in the improvement (p < .05) in diabetes self-efficacy, diabetes knowledge, bicultural efficacy, family emotional and instrumental support, diabetes quality of life, and diabetes distress. Prolonged benefits were evident in all changed variables 2 months post-intervention. The CBPR approach enabled the development of a culturally acceptable, efficacious behavioral intervention, and provides a model for working with communities that demonstrate health disparities.

Social Relationships and Health Among Chinese Americans With Diabetes: Does Age Make a Difference?

This study examined whether social relationships were linked to health among Chinese Americans with diabetes, and whether age moderated these links given the norm of respect for the elderly. Chinese American immigrants with type 2 diabetes (n= 163) provided questionnaire and laboratory data. Relationships were assessed with diabetes family instrumental support, emotional support, and conflicts, as well as general support. Health was assessed with subjective health, depressive symptoms, and glucose regulation. When relationship predictors were examined simultaneously, more conflicts and less general support were associated with more depressive symptoms, after adjusting for covariates. More emotional support was associated with better glucose regulation only for midlife, not older, participants. Findings underscore cultural and life-stage considerations in studying social determinants of health.

Gender Differences in Factors Related to Diabetes Management in Chinese American Immigrants

Chinese American women with type 2 diabetes (T2DM) are more vulnerable to poor diabetes outcomes than men because immigrant status, ethnicity, and economics intersect with gender to diminish disease management opportunities. We explored gender differences in factors associated with diabetes management at intake and after treatment with a behavioral intervention in first-generation Chinese American immigrants. A sample of 178 Chinese Americans with T2DM was enrolled in a single-cohort, repeated-measures delayed-treatment trial. Data were collected at baseline, 8, 16, 24, and 32 weeks with 6-week treatment provided after 16 weeks. Gender differences at baseline and gender by treatment interactions were noted. Women at baseline reported significantly worse depressive symptoms and general health. Significant gender by treatment interactions were observed for diabetes self-efficacy, bicultural efficacy, family instrumental support, and diabetes quality of life–satisfaction. Only women showed improvement, suggesting women benefited more from the intervention in psychosocial factors related to diabetes management.

The San Francisco Chinese Food Security Module: Validation of a Translation of the US Household Food Security Survey Module

There are no validated scales for measuring the prevalence of food insecurity among U.S. Chinese speakers. We validated the newly developed SF Chinese Food Security Module (a translation of the U.S. Household Food Security Survey Module) among 483 Chinese-speaking adults at a street fair. Most (8/10) of the translated items performed well compared to national statistics. Food insecure households had lower income and higher financial stress and used more food coping strategies. We conclude that the translated scale successfully identifies food insecure households in a community-based sample of Chinese-speaking adults. The module is suitable for use among Chinese American immigrants, although further development is needed to assess severe food insecurity.