Please read the following article, and address the questions that appear below in a four-
Song, H., Han, H., Lee, J., Kim, J, Kim, K.B., Ryu, J.P., & Kim, M. (2010). Does access to
care still affect health care utilization by immigrants? Testing of an empirical explanatory
model of health care utilization by Korean American immigrants with high blood pressure.
Journal of Immigrant Minority Health, 12, 513-519.
- What research question did the authors set out to answer?
- What research hypothesis was tested in this study?
- What study design was employed in the study? What (if any) type of bias is inherent to
- Summarize the univariate findings displayed in Table 1.
- Summarize the bivariate findings reported in Table 2.
- What limitations were noted with regard to the study’s findings and conclusions?
The authors of the article in the case study set to address the aspect of whether access to
care affected health utilization by immigrants. The researchers opted to address this question
because, according to other studies, access to healthcare by all people has not been adequate and
satisfactory. As such, people from immigrant ethnic minorities in the US are not guaranteed
quality, sufficient and equitable care.
In addition, studies have also indicated that a good number of US citizens cannot access
adequate and proper health care. An example is derived from US Immigrants of Korean origin
who is hindered from accessing quality health care owing to their cultural and language barriers.
Moreover, many of these people are unlikely to be insured against their health due to their
perceived low-income level (Aday, 1993). This subsequently results to poor health, low use of
health services, and low quality health care. Studies have also indicated that ethnic minorities are
IMMIGRANT MINORITY HEALTH: CASE STUDY 2
found to have a higher prevalence of chronic ailments such as cancer, diabetes, high and low
blood pressure in comparison with their white counterparts (Juon, 2000).
Though it has generally been presumed that insufficient utilization of health care is one
of the elements influencing early prevention and sufficient management of the chronic
ailments such as those mentioned above, research on the problems and enhancement in
implementation of effective strategies to facilitate sufficient utilization of health services by
immigrants has been insufficient(Ham and Lee, 2007). It is therefore, out of this reason that the
researchers sought to conduct an extensive study to find out how access to healthcare affected
health utilization by ethnic minorities. They do this by examining the predictive capability of a
model in health care utilization, through analysis of the interrelations of the enabling,
predisposing as well as the need elements. They then go on to examine how these elements affect
the health care utilization by underserved minority groups such Korean immigrants with chronic
The researchers noted that there was a need of conducting empirical studies to clarify the
problems related with immigrant healthcare as well as finding out enhanced strategies that could
ensure sufficient healthcare utilization by the immigrants groups such as the Korean American
Immigrants. The researcher further articulate that owing to many research gaps, there was also a
critical need for researchers to come up with a theoretical framework that can be employed to
understand better underserved immigrant minorities.
The hypothesis for this study was that; enabling, predisposing and need factors
significantly contributed to the health care utilization by Korean American immigrants (Hee, et
IMMIGRANT MINORITY HEALTH: CASE STUDY 3
al, 2009). The perceived income level and period that the individuals had resided in America
influenced the healthcare utilization. According to the scholars’ model, clinical symptoms that
were self-reported, an individual’s health history and need factors were hypothesized to directly
impact on the healthcare utilization among the immigrant minorities. Enabling factors such as
perceived income level, and health insurance played a crucial role in prediction of health care
utilization in these groups. Predisposing elements such as the period of one’s residency in US,
as well as competing priorities were also presumed to directly or indirectly affect utilization of
health care through the need and enabling factors (Han, 2007).
The research design used in this study was a case study research design. Participants used
in the case study included middle aged Korean American Immigrants with high blood pressure in
Baltimore region, Washington D.C. 445 such participants were included in the study. Trained
nurses acted as research assistants and were involved in the collection of data through
distribution of questionnaires that were structured to the participants.
The model used by the researchers was the one developed by Anderson (1995). This
model acted as the framework for organizing the theoretical positions and the study variables. On
the analysis of the interplay between the enabling, predisposing and need elements. The
statistical analysis performed by the researcher showed a favorable fit the model proposed. In
general, the model included 18% of the variance in utilization of the healthcare by the Korean
IMMIGRANT MINORITY HEALTH: CASE STUDY 4
In accordance to the Univariate findings in table 1, majority of the participants 73.7%
indicated that they experienced a family history of high blood pressure. On the other hand,
13.9% of the participants had experienced consistent high blood pressure associated with kidney
problems while only 13.1% of them had encountered diabetes. The correlation matrix of
enabling, predisposing and need elements indicated that various variables were related to
utilization of health care at the vicariate level. The study also indicated that married participants
had stayed longer in America, acquired health insurance and had a likelihood of seeking medical
care in case they experienced high blood pressure. The study further revealed that there was
some extent of correlation among enabling, predisposing and need elements. For instance, the
period one resided in America was noted to be significantly related to acquisition of health
insurance, and one’s level of income. A correlation was also noted between health insurance
status and life priorities; those giving HBP and health status a priority were likely to have a
In the bivariate findings, individual’s income level, and health insurance were found to
have a direct, total, strongest and direct effect on healthcare utilization. However, the predicted
High blood pressure did not indicate a direct impact on utilization of health care in this study, (its
path coefficient was only 0.13). Though the researchers had hypothesized that the period of
residency in America and an individual’s level of income affected healthcare utilization among
immigrants, findings of their study revealed that the elements had indirect and moderate effects
through health care and health insurance utilization by the Korean American Immigrants.
IMMIGRANT MINORITY HEALTH: CASE STUDY 5
Consequently, participants who harbored a high level of income considered care in high blood
pressure a priority over other issues. Those who had lived longer in America had a likelihood of
obtaining health insurance. This subsequently led to regular utilization of healthcare. In general,
the explanatory variable in the researchers’ trimmed model constituted 18% of the variance
results in health care utilization.
The authors of the study were frank to reveal that their study findings ought to be
interpreted with caution. One of the reasons was that the research sample was extracted from a
single ethnic group, Korean American Immigrants. This limited the extent to which the various
inferences could be considered with regard to other ethnic minority groups in US, considering
that each ethnic group had its own characteristics.
The authors also postulated other variables in this aspect such as the degree of language
barrier and acculturation stress that could also affect utilization of healthcare by immigrant
groups were left out in the study. As such, future studies of similar nature should incorporate
these elements in their models of access to health care. This could facilitate enhanced
interpretation of the status of utilization of health care by immigrant minority population. The
researchers also recommend that in related future studies, researchers should separately study
the availability of health care practitioners, and the degree of accessibility of similar linguistic
and cultural minorities to present a more enhanced image of utilization of healthcare by
IMMIGRANT MINORITY HEALTH: CASE STUDY 6
Anderson RM. (1995). “Revisiting the behavioral model and access to medical care: does it matter?” J
Health Soc Behav. 1995;36:1–10. 4.
Aday LA. (1993), “At risk in America: the health and health care needs of vulnerable
populations in the United States”. San Francisco: Jossey-Bass Publishers; 1993.
Hee,J., Hae-R,H., Jong-E., Lee K, Ji K.B.,Jai P.R.,Miyong K, (2009). “Does Access to
Care Still Affect Health Care Utilizationby Immigrants? Testing of an Empirical
Explanatory Model of Health Care Utilization by Korean American Immigrants with
High Blood Pressure”. Ó Springer Science+Business Media, LLC 2009
Ham, O.K., Lee C.Y.(2007), “Predictors of health services utilization by hypertensive patients in
South Korea”. Public Health Nursing,; 24(6):518–28.