E-Shien Chang

Integrating cultural humility into health care professional education and training

As US populations become increasing diverse, healthcare professionals are facing a heightened challenge to provide cross-cultural care. To date, medical education around the world has developed specific curricula on cultural competence training in acknowledgement of the importance of culturally sensitive and grounded services. This article proposes to move forward by integrating the concept of cultural humility into current trainings, in which we believe, is vital in complementing the current model, and better prepare future professionals to address health challenges with culturally appropriate care. Based on the works of Chinese philosophers, cultural values and the contemporary Chinese immigrants’ experience, we hereby present the QIAN 謙 (Humbleness) curriculum: the importance of self-Questioning and critique, bi-directional cultural Immersion, mutually Active-listening, and the flexibility of Negotiation. The principles of the QIAN curriculum reside not only between the patient and the healthcare professional dyad, but also elicit the necessary support of family, health care system as well as the community at large. The QIAN curriculum could improve practice and enhance the exploration, comprehension and appreciation of the cultural orientations between healthcare professionals and patients which ultimately could improve patient satisfaction, patient-healthcare professional relationship, medical adherence and the reduction of health disparities. QIAN model is highly adaptable to other cultural and ethnic groups in multicultural societies around the globe. Incorporating its framework into the current medical education may enhance cross-cultural clinical encounters.

How do U.S. Chinese older adults view elder mistreatment?: findings from a community-based participatory research study.

Objectives: This study examines the perception, knowledge, and help-seeking tendency toward elder mistreatment among Chinese older adults. Method: A community-based participatory research approach was implemented to partner with the Chicago’s Chinese community. A total of 39 Chinese older adults (age 60+) participated in focus group interviews. Data analysis is based on grounded theory framework. Results: Chinese older adults mostly characterized elder mistreatment in terms of caregiver neglect and identified psychological mistreatment as the most serious form of mistreatment. Other forms included financial exploitation, physical mistreatment, and abandonment. Chinese older adults have limited knowledge of help-seeking resources other than seeking assistance from local community service centers. Discussion: This study has important practical implications for health care professionals, social service agencies, and concerned family members. Our results underscore the need for research and educational initiatives as well as community awareness programs that highlight the pervasive public health issue of elder mistreatment.

Elder Abuse and Psychological Well-Being: A Systematic Review and Implications for Research and Policy - A Mini Review

Elder abuse and psychological distress are both important geriatric syndromes and are independently associated with premature morbidity and mortality. Despite recent advances, there has been little systematic exploration of the association between elder abuse and psychological distress. This systematic review synthesizes the qualitative and quantitative studies on the relationship between elder abuse and psychological distress, namely psychological distress as a risk factor and/or a consequence of elder abuse. Moreover, through this review, future research directions for elder abuse and psychological distress and their implications for practice and policy to improve the health and aging of vulnerable populations are also highlighted.

Perception and negative effect of loneliness in a Chicago Chinese population of older adults

This qualitative study aims to investigate the cultural understandings of loneliness, identify the contexts of loneliness, and to examine its effect on the health and well-being of U.S. Chinese older adults. Despite loneliness is one of the main indicators of well-being, little attention has been paid to understanding loneliness among immigrant older adults. This study utilizes both survey questionnaires and semi-structured focus group methods to investigate the feelings of loneliness among U.S. Chinese older adults. Based on interviews with 78 community-dwelling Chinese older adults in Chicago Chinatown, this community-based participatory research study (CBPR) shows loneliness is common among U.S. Chinese older adults. It was frequently identified through emotional isolation and social isolation. Social, psychological and physical health factors could contribute to the experience of loneliness. In addition, the health of older adults with loneliness may be associated with worsening overall health, elder mistreatment, health behavior changes and increased healthcare utilizations. This study has implications for healthcare professionals, social services agencies and policy makers. Our findings point to the needs for healthcare professionals to be more alert of the association of loneliness and adverse health outcomes. Communities and social services agencies should collectively take a lead in reducing social isolation, improving intergenerational relationships, and increasing social networks and companionship for this group of vulnerable older adults.

Assessing the health needs of Chinese older adults: Findings from a community-based participatory research study in Chicago's Chinatown

The objective of this study is to examine the cultural views of healthy aging, knowledge and barriers to services, and perception of health sciences research among community-dwelling Chinese older adults in Chicagos Chinatown. This qualitative study is guided by the Precede-Proceed conceptual model with community-based participatory research design. Data analysis is based on eight focus group interviews with Chinese older (age 60+) adults (n = 78). We used a grounded theory framework to systematically guide the thematic structure of our data. Findings show participants described cultural conception of health in terms of physical function, psychological well-being, social support, and cognitive function. The availability, affordability, and cultural barriers towards health care services were major negative enabling factors that inhibit participants from fulfilling health needs. Perception and knowledge of health sciences research were also discussed. This study has implications for the delivery of culturally appropriate health care services to the Chinese aging population.

The Perceptions, Social Determinants, and Negative Health Outcomes Associated With Depressive Symptoms Among U.S. Chinese Older Adults

PURPOSE OF THE STUDY Recent demographic growth of the U.S. Chinese aging population calls for comprehensive understanding of their unique health needs. The objective of this study is to examine the perceptions, social determinants of depressive symptoms as well as their impact on health and well-being in a community-dwelling U.S. Chinese aging population in Chicago. DESIGN AND METHODS A community-based participatory research approach was implemented to partner with the Chicago Chinatown population in a geographically defined community. Data were collected from questionnaires and semistructured focus group interviews with 78 community-dwelling Chinese older adults. RESULTS Our findings suggest that the depressive symptoms were common among older adults. It was frequently identified through feelings of helplessness, feelings of dissatisfaction with life, feelings of getting bored, loss of interests in activities, suicidal ideation, and feelings of worthlessness. Societal conflicts, family conflicts, financial constraints, personality, and worsening physical health may be associated with greater depressive symptoms. In addition, depressive symptoms may be detrimental to the overall health and well-being of Chinese older adults. IMPLICATIONS This study has wide implications for health care professionals, social services agencies, and policy makers. Our results call for improved public health education and awareness programs to highlight the health impact of depressive symptoms on Chinese older adults. Future prospective studies are needed to investigate the prevalence of depressive symptoms among U.S. Chinese older adults. Longitudinal research is needed to quantify the risk and protective factors of depressive symptoms.

Prevalence of suicidal ideation, attempts, and completed suicide rate in Chinese aging populations: A systematic review

BACKGROUND As one of the leading causes of death around the world, suicide is a global public health threat. Due to the paucity of systematic studies, there exist vast variations in suicide ideation, attempts and suicide rates between various regions of Chinese aging communities. OBJECTIVES Our systematic study aims to (1) identify studies describing the epidemiology of suicidal ideation, suicide attempts and behaviors among global Chinese communities; (2) conduct systematic review of suicide prevalence; (3) provide cross-cultural insights on this public health issue in the diverse Chinese elderly in China, Hong Kong, Taiwan, Asian societies and Western countries. DATA SOURCES Using the PRISMA statement, we performed systematic review including studies describing suicidal ideation, attempts, and behavior among Chinese older adults in different communities. Literature searches were conducted by using both medical and social science data bases in English and Chinese. RESULTS Forty-nine studies met inclusion criteria. Whereas suicide in Chinese aging population is a multifaceted issue, culturally appropriate and inter-disciplinary approach to improve the quality of life for the Chinese older adults is critical. CONCLUSIONS Future research is needed to explore the risk and protective factors associated with suicidal thoughts, attempts and behaviors in representative Chinese aging populations.

A psychometric assessment of the psychological and social well-being indicators in the PINE study.

Objective: This report aims to establish the reliability and validity of five psychological and social well-being indictors in their applications to a U.S. Chinese aging population. Method: The Population Study of Chinese Elderly in Chicago (PINE) is a population-based epidemiological study of Chinese older adults in the Greater Chicago area. Internal consistency reliability was assessed by determining the coefficient alpha and inter-item correlation coefficients. Content validity was assessed by bilingual and bicultural study researchers and community leaders. Results: The reliability and validity analysis supported the use of the Chinese version of the psychological and social well-being indicators in the PINE study. The value of Cronbach’s alpha for fives scales ranged from .64 to .82, indicating reasonable internal consistency. Content validity was established through intensive review by a panel of experts. Discussion: The instruments discussed in this report are reliable and valid measures to assess key dimensions of psychological and social distress of Chinese older adults.

The Prevalence of Loneliness Among U.S. Chinese Older Adults

Objective: Loneliness is an important indicator of well-being. However, we have limited understanding of loneliness in minority aging populations. This study aims to identify the prevalence of loneliness among U.S. Chinese older adults. Method: Data were drawn from the PINE study, a population-based study of 3,159 U.S. Chinese older adults in the Greater Chicago area. Results: Our findings indicated that the prevalence of loneliness was 26.2%. Older adults with older age, female gender, and living alone reported higher prevalence of loneliness. Older adults with worsened health status, poorer quality of life, and negative health changes over the past year were also more likely to experience loneliness. Discussion: Loneliness is common among U.S. Chinese older adults in the Greater Chicago area. Future longitudinal studies are needed to improve the understanding of risk factors and outcomes associated with loneliness in Chinese older adults.

Suicide in the Global Chinese Aging Population: A Review of Risk and Protective Factors, Consequences, and Interventions

As one of the leading causes of death around the world, suicide is a global public health threat. In the Chinese population, suicides constitute one-fifth of all recorded suicides in the world. Despite the factual data on suicide rates, the understanding of various causal factors behind suicide, including risk and protective factors and adverse health care, remained incomplete among the global Chinese aging population. To fill in the knowledge void, this paper reviews the epidemiology of suicide among Chinese older adults globally as well as explores the existing intervention strategies. Using the PRISMA statement, we performed a systematic review of exiting research on the topic, including studies describing suicide among Chinese older adults in communities outside of Asia. A literature search was conducted online by using both medical and social science data-bases. Our findings highlighted that elderly suicide in Chinese populations is significantly affected by the social, cultural, and familial contexts within which the individual lived prior to committing suicide. Reviewing such research indicated that while reducing risk factors may contribute to lowering suicides amongst Chinese older adults, measures to improve protective factors are also critical. Support through ongoing family and community care relationships is necessary to improve resilience in older adults and positive aging. Future longitudinal studies on the risk factors and protective factors, and adverse health consequences are called for to devise culturally and linguistically appropriate prevention and intervention programs in global Chinese aging populations.