Assessing the Health Needs of Chinese Older Adults: Findings from a Community-Based Participatory Research Study in Chicago's Chinatown

Table 2

Knowledge and Barriers to Health Care Services in the Community.

Themes	Subthemes	Representative statements
Cultural and linguistic barriers	Major barriers in terms of language and culture result in older adults’ dependency on others when it comes to medical visits	“The biggest problem is the language barrier. We feel helpless since we do not speak English, and we cannot resolve matters without English. Even if you understand English you would not comprehend their technical terms.” “The people I contact are few. I don’t want to bother my children.”
	Immediate family support may not always be available to assist older adults with medical visits	“If you need your son to bring you to the doctor’s clinic, he would have no time because he has to work. If you cannot find someone else, then you just have to wait until he comes home.” “To ride the bus you need to know how to get there… you need to draw it on a piece of paper with the directions. I was to take bus no. 4, and it would transfer three times. But still I did not make it (to the hospital). I was lucky to return home from the final bus stop.”
Affordability of services	The health care system is poorly understood. The utilization and degree of satisfaction differ depending on older adults’ insurance coverage and length of residence	“As new comers, we have nothing. My mother-in-law is old, and, moreover, I am old too, I am sixty eight years old. As we age, the most critical thing is medical treatment and benefits. Getting your white card, it would not be a big deal even if you are sick. We depend on the medical supply by mail. It is tough to see a doctor. Besides it is far away. And not knowing English, it is difficult to visit a doctor. The medical expenses are high.” “It’s like we have to pay for everything. We have nothing and yet we need to pay for the medication expenses.”
	For those who are fully insured, they feel fortunate compared to that of their counterparts in China	“Buying insurance is now only getting started in China. Previously, I bought insurance. Now I apply for low-income status. So I do not have to buy insurance and it is so much better. America is definitely taking that route. You have no money. The government helps out with a low income status. If you apply, it will not cost you any money.” “I think the most pleasant thing for me in the US is what happened to my two legs. My legs were broken twice in the US if that happened in China, my children and I would not be able to afford the surgeries. Here in the US, I do not have to pay a single cent. They even provided me the walking equipment and the toilet pans. I think this is the best thing happened to me. I feel very happy and thankful for that.”
Availability of services	The long wait and inflexibility of health care services often frustrated participants	“I think the waiting period to see a doctor is too long. It takes several hours and you are not seeing your doctor right away. Definitely it is too long.” “I think there is something that America is not comparable to China. That is the appointment system. They are not letting you see the doctor today, unless you are going to the emergency room! They will not let you see the doctor right away; it would take a week. Then you need to go to the emergency room. I think that situation is not good.”
	The expectation toward medical visits is often compared to older participants’ experience in China where quick improvement is anticipated	“In Shanghai, if I do not feel good, I can go to see the doctor right away. Over here, this appointment thing, you would need two weeks to see your family physician. He has his vacations and you need to wait two weeks. But hey, I am sick… I have this illness and I need to see the doc right away. I think over here, you need to go to the hospital, the UIC Hospital. It is because of the insurance that requires you to visit the hospital. Today you can visit this hospital and tomorrow you can visit that hospital. And that is OK.” “Like suffering from nerve pain… if you are in China, you just visit the clinic to get a pain killer shot. Over here the waiting period is not fast. I went there and took several hours. Going to the hospital for minor ailments is not convenient.”

Note: table presents a summary of findings from focus group discussions among participants