Jenny Hsin Chun Tsai

Developing culturally competent health knowledge: Issues of data analysis of cross-cultural, cross-language qualitative research

There is a growing awareness and interest in the development of culturally competent health knowledge. Drawing on experience using a qualitative approach to elicit information from Mandarin- or Cantonese-speaking participants for a colorectal cancer prevention study, the authors describe lessons learned through the analysis process. These lessons include benefits and drawbacks of the use of coders from the studied culture group, challenges posed by using translated data for analysis, and suitable analytic approaches and research methods for cross-cultural, cross-language qualitative research. The authors also discuss the implications of these lessons for the development of culturally competent health knowledge.

Occupational hazards and risks faced by Chinese immigrant restaurant workers.

Historically, Chinese immigrants to the United States have worked in restaurants to support their families. Hazards and risks associated with this populations work in restaurants are underrepresented in the literature. This ethnographic study used interviews, participant-observations, and follow-up focus sessions with 18 immigrants from China, Hong Kong, and Taiwan to identify potential physical, biological, enviromechanical, chemical, and psychosocial hazards that they face. Psychosocial hazards were most often mentioned by the participants; biological hazards were not identified in the data. Practice and research implications for addressing health disparities in this population are discussed.

An Injury Prevention Strategy for Teen Restaurant Workers Washington State's ProSafety Project

High levels of youth employment, workplace hazards, and characteristics unique to adolescents contribute to a relatively high incidence of injuries among teens in the restaurant industry. This article discusses the ProSafety model of injury prevention among teen restaurant workers. Through integration with an existing career and technical education program, the ProSafety project seeks to prevent occupational injuries among the teen worker population through classroom safety education and internship skills reinforcement. ProSafety is the product of an innovative collaboration with occupational health nurses, business professionals, educators, and government. Its approach is derived from Social Cognitive Theory, is consistent with key values and strategies of occupational health nurses, and provides lessons for practitioners seeking to reduce occupational injuries in food service or among other populations of adolescent workers.

Impact of social discrimination, job concerns, and social support on filipino immigrant worker mental health and substance use

BACKGROUND The personal and social impact of mental health problems and substance use on workforce participation is costly. Social determinants of health contribute significantly to health disparities beyond effects associated with work. Guided by a theory-driven model, we identified pathways by which social determinants shape immigrant worker health. METHOD Associations between known social determinants of mental health problems and substance use (social discrimination, job and employment concerns, and social support) were examined using structural equation modeling in a sample of 1,397 immigrants from the Filipino American Community Epidemiological Study. RESULTS Social discrimination and low social support were associated with mental health problems and substance use (P < 0.05). Job and employment concerns were associated with mental health problems, but not substance use. CONCLUSIONS The integration of social factors into occupational health research is needed, along with prevention efforts designed for foreign-born ethnic minority workers.

Smoking and the Asian American Workforce in the National Latino and Asian American Study

BACKGROUND Smoking among the Asian American workforce has not been extensively researched. This study examines smoking prevalence among a nationally representative sample of Asian Americans with an emphasis on occupational classification. METHODS Cross-sectional data come from the National Latino and Asian American Study. Multivariate logistic regression analyses were used to determine smoking prevalence by occupation, gender, and nativity, among 1,528 participants self-identifying as in the labor force. RESULTS Blue collar workers reported the highest smoking prevalence (32%) followed by unemployed (19%), other (17%), service (14%), and white collar (10%). Among both employed males and females, blue collar workers had the highest prevalence (45% and 18%, respectively). By nativity, smoking was highest among blue collar workers for immigrants (25%) and highest among the unemployed for U.S. born (16%). Blue collar employment was significantly associated with being a current smoker (OR = 2.52; 95% CI: 1.23-5.16; P < 0.05) controlling for demographics (e.g., age, gender, ethnic group, nativity, etc.). CONCLUSIONS Findings reveal that smoking differs by occupation among Asian Americans. Future research should examine factors explaining differences while considering gender and nativity.

Managerial and Organizational Discourses of Workplace Bullying.

OBJECTIVE: To explore how workplace bullying is addressed by hospital nursing unit managers and organizational policies. BACKGROUND: Although workplace bullying is costly to organizations, nurses report that managers do not consistently address the issue. METHODS: This study used discourse analysis to analyze interview data and policy documents. RESULTS: There were differences in the manner in which managers and the policy documents labeled bullying-type behaviors and discussed the roles and responsibilities of staff and managers. Policies did not clearly delineate how managers should respond to workplace bullying. CONCLUSIONS: These differences can allow management variation, not sanctioned by policy. Unclear policy language can also offer insufficient guidance to managers, resulting in differential enforcement of policies.

An investigation of organizational and regulatory discourses of workplace bullying

Organizations use policies to set standards for employee behaviors. Although many organizations have policies that address workplace bullying, previous studies have found that these policies affect neither workplace bullying for targets who are seeking assistance in ending the behaviors nor managers who must address incidents of bullying. This article presents the findings of a study that used critical discourse analysis to examine the language used in policies written by health care organizations and regulatory agencies to regulate workplace bullying. The findings suggest that the discussion of workplace bullying overlaps with discussions of disruptive behaviors and harassment. This lack of conceptual clarity can create difficulty for managers in identifying, naming, and disciplining incidents of workplace bullying. The documents also primarily discussed workplace bullying as a patient safety concern. This language is in conflict with organizations attending to worker well-being with regard to workplace bullying.

Effects of Social Determinants on Chinese Immigrant Food Service Workers' Work Performance and Injuries: Mental Health as a Mediator.

Objective: The effects of social discrimination, job concerns, and social support on worker mental health and the influence of mental health on occupational health outcomes have been documented intermittently. We propose an integrated, theory-driven model to distinguish the impact of social determinants on work performance and injuries and the mediating effects of mental health problems. Methods: The US Chinese immigrant food service workers (N = 194) completed a multimeasure interview; we tested the integrated model using structural equation modeling. Results: Mental health problems, which were associated with decreased work performance and increased injuries, also mediated relationships between job/employment concerns and both work performance and injuries but did not mediate the influences of discrimination and social support. Conclusions: This research reveals mechanisms by which social determinants influence immigrant worker health, pointing to complementary strategies for reducing occupational health disparities.

A multi‐sector assessment of community organizational capacity for promotion of Chinese immigrant worker health

BACKGROUND Community-based collaborative approaches have received increased attention as a means for addressing occupational health disparities. Organizational capacity, highly relevant to engaging and sustaining community partnerships, however, is rarely considered in occupational health research. METHODS To characterize community organizational capacity specifically relevant to Chinese immigrant worker health, we used a cross-sectional, descriptive design with 36 agencies from six community sectors in King County, Washington. Joint interviews, conducted with two representatives from each agency, addressed three dimensions of organizational capacity: organizational commitment, resources, and flexibility. Descriptive statistics were used to capture the patterning of these dimensions by community sector. RESULTS Organizational capacity varied widely across and within sectors. Chinese and Pan-Asian service sectors indicated higher capacity for Chinese immigrant worker health than did Chinese faith-based, labor union, public, and Pan-ethnic nonprofit sectors. CONCLUSIONS Variation in organizational capacity in community sectors can inform selection of collaborators for community-based, immigrant worker health interventions.

Implementation research and Asian American/Pacific Islander health

Numerous barriers prevent the translation of research into practice, especially in settings with diverse populations. Nurses are in contact with diverse populations across settings and can be an important influence to further implementation research. This paper describes conceptual approaches and methodological issues pertinent to implementation research and implications for Asian American/Pacific Islander (AAPI) health research. The values of using theory to guide implementation research, levels of theory that are commonly used in interventions, and decisions for theory selection are discussed. In addition, shortcomings of randomized controlled trials, the gold standard for testing efficacy of interventions, and present quasi-experimental designs as a plausible alternative to randomized controlled trials when research is conducted in real-world settings are explored. Also examined were three types of quasi-experimental designs, the unit of analysis, the choice of dependent variables, and measurement issues that influence whether research findings and evidence-based interventions are successfully translated into practice. Practicing nurses who are familiar with the AAPI population, as well as nurse researchers who have expertise in AAPI health can play critical roles in shaping future implementation research to advance AAPI health. Nurses can provide practice-based evidence for refining evidence-supported interventions for diverse, real-world settings and theory-based interventions that are socioculturally appropriate for AAPIs. Interdisciplinary, practicebased research networks that bring multiple agencies, organizations, communities, and academic institutions together can be a mechanism for advancing implementation research for AAPI health.