Acculturation and Barriers to Health Care Among Cambodian Women

Brief communication 341 ACCULTURATION AND BARRIERS TO HEALTH CARE AMONG CAMBODIAN WOMEN Since the fall of Saigon in 1975, more than 900,000 Southeast Asians (Vietnamese , Laotians, Hmongs, and Cambodians) have resettled in the United States.1 Approximately 180,000 Cambodians, including the children born after arrival, currently live in the United States.1 Nearly 7,000 Cambodians live in Texas, the majority in the Houston area.2 The Cambodian population's rapid expansion in Houston and the demonstrated need for health services among Asian Americans generally led the author to conduct the present study. Previous studies3"9 showed that of all the Southeast Asian refugees and immigrants in the United States, Cambodian women are among the least educated, most often ill, and most in need of preventive health services. Furthermore, the Cambodian-American population remains one of the most poor and underserved minority groups in the United States. Health beliefs and health practices in Cambodia are complex and varied. Many uneducated Southeast Asians know little about some concepts that are basic in Western medicine, such as germ theory, anatomy, and physiology.6"14 Health care practitioners in Cambodia include relatives, spirit healers, Buddhist monks, and herb vendors, as well as Western doctors.1011 Accepted causes of illness include spirits, winds, and yin/yang imbalance. Treatments used include coin rubbing (for pain, colds, vomiting, and headaches), cupping (using a cup in which a vacuum has been created by briefly blowing an alcoholsoaked cotton ball inside the cup and then placing the cup on the pain site, usually the forehead), pinching (for headaches), and ritual performance by practitioners (to appease the spirit). While the majority of Cambodians have resettled successfully, there is growing evidence that a significant number of Cambodians experience considerable emotional distress long after relocating to the United States.711"14 In addition to these health and health-related problems , Cambodian Americans challenge the U.S. system for preventive health care in that they differ from the U.S.-born in disease patterns, knowledge, and utilization of preventive health services. Little is known about access to health care or the health status of Asian Americans in Texas. Data for this group generally have appeared in an "other" category, which serves no useful purpose when it comes to understanding the group's circumstances. Much of the relatively little data on the health status of Asian Americans are aggregated. This Received February 22,2002; revised September 5,2002; accepted November 20,2002. Journal of Health Care for the Poor and Underserved · Vol. 14, No. 3 · 2003 DOI: 10.1177/1049208903255444 342 Acculturation aggregation of data has perpetuated the myth that Asian Americans are healthier than the total population. Limited data show underutilization of preventive health services such as breast and cervical cancer screening among Cambodian American and other Asian American women.8,9·14"20 The current study was designed to assess (1) access to health care and barriers to health care among Cambodian American women, and (2) the extent to which this access to health care and use of preventive health services varied with level of acculturation. Level of acculturation previously has been linked to health behaviors and use of health services among Asian Americans.8,14"18 Method The sampling frame consisted of 506 Cambodian households in Houston. Because no other source of names was available, the households participating in this study were identified through the assistance of various Cambodian community organizations (e.g., Refugee Service Alliance, Houston Cambodian Community Organization). The other known listings of the Cambodian members of the community belonged to a private agency that had a policy not to distribute the names outside their institution. Community informants, however, told the investigator that more than 50 percent of the Cambodian households in Houston are members of the Houston Cambodian Community Organization and that most households have telephones. About 18 percent of the households in the sample list could not be reached due to an incorrect or unknown telephone number. Nine and four-tenths percent of the households were ineligible, because no woman in the household met the age requirements or there was no eligible woman present at the time of the interview. The refusal rate was...