Barriers to the use of health services by Chinese Americans.

This study examined the extent to which cultural, socioeconomic, and systemic factors impeded access to and utilization of health services among a convenience sample of 52 Chinese immigrants living in metropolitan Houston. The subjects, of differing levels of socioeconomic status, were 25 years old or older. Methods used for data collection included participant observation, face-to-face interview, and case study. A semistructured interview instrument with open- and closed-ended questions was administered. A pilot study and expert reviews were conducted for content and face validity. Cultural and socioeconomic factors were found to be strongly associated with access to and utilization of health services. Mainland Chinese and Taiwanese shared similar cultural dilemmas as they sought health care, including communication difficulties, beliefs about health, health care, and illness, and mistrust in Western health care. Although families played important roles in health decisions and choices of services, social class differences also appeared to affect utilization. For example, more affluent Taiwanese than Mainland Chinese were apt to carry health insurance and use Western systems. The findings suggest a need to improve services to the Chinese community through family-centered and community-based approaches adapted to Chinese culture.