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Asian immigrants are the fastest growing immigrant population in the United States. The literature documents that Asian immigrant parents of children with developmental disabilities (DD) face additional barriers when they access and utilize services in the United States, compared to U.S.-born parents. However, we have a limited understanding of how they respond to these barriers and what they want to achieve while supporting their child with DD, especially when their children transition from high school to adulthood. While there are some studies about Asian immigrant parents of children with DD, these studies singularly attribute barriers to cultural differences between Asian immigrant parents’ cultural backgrounds and the mainstream American culture. Furthermore, previous research has only documented parents’ experiences at one time point, thus limiting the understanding of the potential influence of acculturation when Asian immigrant parents support their child with DD in the United States over time. To achieve the goal of this dissertation, which is to understand how and why Asian immigrant parents are involved in the lives of their child in relation to their acculturation process, I conducted two qualitative studies grounded in role theory and acculturation theory. In study 1, I built on previous qualitative studies related to Asian immigrant parents’ experiences while accessing and utilizing services for their child with DD by conducting a meta-synthesis. I identified 11 qualitative studies for analysis, and examined these studies using a constant comparative approach and thematic analysis. Based on the analysis, I proposed a theoretical framework to describe parents’ role enactment as an evolving process influenced by acculturation that spirals them towards their ultimate parental goal of helping their child with DD thrive and live happily. The framework also describes how system factors are intertwined with parents’ individual factors to facilitate or impede their role enactment. In study 2, to address the lack of understanding of how Asian immigrant parents’ experiences while supporting their child with DD transition to adulthood, I conducted a narrative study with five Chinese-speaking immigrant parents whose children with DD were between 20 and 34 years old. Parents participated in a sequence of three, in-depth narrative interviews to share stories about how they perceived and enacted their parental role while supporting their child’s transition to adulthood. I used the listening guide to systematically analyze the data. Participants’ described their perceived parental role as helping their young adult child with DD live a happy and meaningful life. This role included two role facets: helping their child develop independent living skills and planning for their child’s adult life. Parents’ narratives revealed that their role enactment was not only influenced by their lifeworlds, but that parents could also actively shape their lifeworlds. Parents’ perceptions about their capacities to shape their lifewolds varied. Some parents were more empowered to change their lifeworlds, while other parents tended to adjust to their lifeworld. Parents’ cumulative interactions with American society gradually shaped how they framed their experiences of role enactment and the way they enacted their parental role. Parents felt it was “just harder” for them to enact their parental role as immigrants. Despite this, parents’ perceived the societal attitudes towards disability in American society positively influenced their role enactment and made them feel that the United States could be home for their family. Together, these two studies highlighted that parents’ role enactment is a dynamic temporal process, which is influenced by their cumulative interactions with components in their lifeworlds. Although Asian immigrant parents experience unique challenges related to their status as immigrants while enacting their parental role, they demonstrated resilience in the face of these challenges. The findings of this dissertation can inform researchers’ and practitioners’ understandings of how to develop parent interventions for Asian immigrant parents to help their child thrive and live happily and how to create a culturally safe environment to facilitate realization of their desired role.

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Health literacy is not only the ability to read, but also the ability of an individual to obtain, process, and understand the basic health information needed to make appropriate health decisions. Over time the concept of health literacy has evolved from considering it a risk factor to be managed to considering it an asset which can be continually built upon. With this in mind health professionals should continue to communicate in simple language, but should also provide their patients with high-quality educational materials and aid them in making the best choices about their health. One way to do this could be with the use of symptom-checking and decision-aiding smartphone apps. In this study, the primary caretakers of children aged 30 months and younger with publicly funded health insurance will be randomized to receive a pediatric symptom-checking smartphone app or a developmental milestone smartphone app. Caretaker health literacy will be measured, and data will be collected on emergency department and primary care office sick visits. It is hypothesized that the use of the pediatric symptom-checking smartphone app will decrease non-urgent visits to the pediatric emergency department. / Urban Bioethics

Health literacy is a social determinant of health and health disparity and low health literacy contributes to poor health outcomes in ethnic minority young adults (EMYAs). There is a gap in the literature regarding the health literacy readiness (HLR) of EMYAs transitioning to adulthood. The overarching research question concerned the perspectives of EMYAs on HLR for the transition to adulthood. A phenomenological study design was used with a theoretical framework that integrated concepts from the socioecological and health belief models. Twelve purposefully selected EMYAs ages 18-22 from a southern U.S. county participated in the study. Data were collected by telephone using semistructured interviews. The interview questions centered on EMYAs' self-assessed HLR for the transition to adulthood, attitudes and beliefs about HLR, barriers to and benefits from HLR, and facilitators of HLR for the transition to adulthood. Recorded data were transcribed and analyzed, spirally coded, and reduced into overarching themes. Three categories emerged: deficient acumen, access problems, and application challenges. Results showed that EMYAs viewed HLR as vital for the transition to adulthood, though 92% reported low HLR. EMYAs reported individual factors; available time and deficient knowledge; and social factors, family support, and deficient school education as influencing their HLR. The study findings revealed poor HLR in EMYAs but identified areas that can be targeted to improve HLR. Results may contribute to positive social change by providing health educators with knowledge they can use to enhance community health engagement strategies and develop culturally sensitive interventions aimed at improving HLR in EMYAs.

Purpose: The purpose of this study is to examine parental Functional Health Literacy and their child’s subsequent utilization of dental services. Methods: This was a prospective cohort study of children (n=1175) enrolled in the Child Health Investment Partnership of Virginia (CHIP). Descriptive statistics and separate multivariate logistic regressions were used to determine the relationship between functional health literacy measures; 1) Health Care Literacy (HCL), 2) Personal Health Literacy (PHL), and 3) LSP 22 scale, with utilization as measured as number of dental visit/s. Results: Descriptive analysis of the cohort reveals: 45% black, 40% white, 10% Hispanic, 5% other, 41% of parents not having a high school diploma or GED, >75% were enrolled in CHIP by the age of one, 90% had Medicaid, 80% lived in Roanoke City, 87% had a normal birth weight, 86% were term pregnancies, and 91% did not have asthma. All literacy measures, PHL, HCL, LSP 22, and LSP 22 Target Range were positively associated with having dental utilization. Hispanic race had a less likely chance of having multiple dental visits even when within target range of LSP 22. Conclusion: Parents of children enrolled in CHIP with higher levels of functional health literacy as measured by the Life Skills Progression Instrument demonstrated an increased likelihood of dental utilization for their children.