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Table 4 Language, Immigrant status, and Stigma. Impact of language and sociocultural factors on health decision making and health behaviors

From: Sociocultural barriers to hepatitis B health literacy in an immigrant population: a focus group study in Korean Americans

Theme

Question

Illustrative quotes

Language

How difficult is it to communicate with your providers who don’t speak Korean?

I went to see a Chinese doctor, and we had to communicate in English. It was difficult for me to explain my symptoms clearly, and I was not certain if he understood me correctly.

I have lived in the United States for the past 32 years, and I consider my English fairly good. However, I find it challenging to explain my concerns about CHB in English. Some of the things often expressed in Korean are expressed very differently from English. You cannot literally translate word for word and expect the meaning to be the same.

I only looked for Korean doctors. I have never looked for American doctors due to the language barrier that I knew would be a problem.

I do have a fear of interaction with non-Korean doctors at hospitals. I am not sure how to describe the symptoms I have, and I think because of this, I fear that there will be misunderstandings both ways.

I went to see a doctor and there was an interpreter, who translated for me. Doctor did not ask many questions, and I am not sure if he understood me.

Sociocultural

What are the personal issues that affect you when you plan to see a doctor?

Inter-cultural misunderstanding:

Doctor I met for hepatitis B explained that I need to come to clinic at least 1–2 times a year to make sure nothing bad has happened in my liver. But I am doing fine so I chose not to go back to the clinic.

I do not see why I need a checkup unless I have a symptom.

I visit my Eastern medicine acupuncturist for my regular well-being check ups, and I only visit doctor’s office when I am sick.

Stress and financial with immigrant life:

I definitely feel a certain type of burden when I go to the hospital. I feel that people at the hospital were not as nice as I thought they would be, and I wondered to myself, “Is it because I’m a minority that I’m getting a certain type of treatment?”

I used to be a banker in Korea, but I cannot get a decent job here in the US. Fortunately, my wife is a nurse and has a good job. I feel depressed and thinking about going to see a doctor for my liver is not in my mind.

Healthcare cost is too high in the US. My employer does not provide health insurance for every employee. And I can’t afford insurance now.

Structural:

Many of my Korean friends and I rely on the resources from Korean Community Center. I even get my sugar checked there. They provide me with the information about the doctors, pharmacies and hospitals.

I was referred to a doctor at a university hospital, but it would take 2 months to see him, so I ended up not going.

Stigma

What are the personal things you worry about because you are chronically infected?

When I first got diagnosed, I became more careful around other people. I even ate at a different table because I didn’t want to affect my children.

I have a girlfriend right now, and I am very troubled since she doesn’t know that I am HB infected. If I tell her, I don’t know how she would react. I’m afraid to tell the truth, so in a way, I feel shame...My doctor told me that if she is vaccinated, it wouldn’t affect her. I mean, there is no chance that she would get hepatitis B from me. But even then, I find it difficult to tell her the truth.