title: Health literacy as the missing link in the provision of immigrant health care: A qualitative study of Southeast Asian immigrant women in Taiwan.
abstract: OBJECTIVE
  Language and communication barrier are main contributors to poor health outcomes and improper use of health care among immigrants. The purpose of this study was to explore and understand specific language and communication problems experiences by Southeast Asian immigrant women in Taiwan.
  
  
  METHODS
  This qualitative study used focus groups and in-depth interviews to uncover the experiences of immigrant women regarding their access to and utilization of health care in Taiwan.
  
  
  METHODS
  Eight focus groups were conducted with 62 Southeast Asian immigrant women and 23 individual in-depth interviews with a wide range of stakeholders who had diverse background and intimate knowledge of immigrant-relating health care issues were performed.
  
  
  RESULTS
  Directed content analysis was applied and identified four major themes concerning conditions that influenced immigrant women's use of health information and services: (1) gaining access to health information, (2) navigating in health care delivery system, (3) interactions during health care encounters, and (4) capability of using health information and services. Findings from this study suggest that, without basic language and literate skills, the majority of immigrant women had inadequate health literacy to manage health information and navigate the Taiwan health care system. Interpersonal communication gap between immigrant women and health care providers exists because of lack of health literacy in addition al language and cultural barriers.
  
  
  CONCLUSIONS
  With limited language and health literacy skills, immigrant women face numerous challenges in navigating the health care system, interacting with health care providers, and gaining access to proper health care. Future efforts are necessary to enhance individual's health literacy and establish health literate environment.
authors: School of Nursing, National Yang-Ming University, No. 155, Sec 2, Linong Street, Bei-Tou Dist., Taipei 112, Taiwan. Electronic address: titsai@ym.edu.tw.
authors: Tzu-I
authors: TI
authors: Tsai
authors: Department of Health Management and Policy, The University of Michigan, School of Public Health, 1420 Washington Heights, Ann Arbor, MI 48109-2029, USA. Electronic address: sylee@umich.edu.
authors: Shoou-Yih D
authors: SY
authors: Lee
mesh_terms: D001210:Asia, Southeastern / Q000208:ethnology; D054242:Emigrants and Immigrants; D005260:Female; D057220:Health Literacy; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D013624:Taiwan
keywords: Cultural competent care; Health communication; Health literacy; Language barrier; Navigation and access to health care; Southeast Asian immigrants