Article Title

Understanding Asian Patients' Lower Satisfaction With Health Care

Publication Date



patient satisfaction, racial/ethnic differences


Background/Aims: Asians now exceed Latinos as the highest proportion of new immigrants in the United States, totaling over 18 million. Asian patients report lower satisfaction with their health care than do non-Hispanic white (NHW) patients. The goal of this comparative, mixed-methods study was to explore Asian patients’ expectations and experiences with health care compared to NHW patients as well as how cultural norms related to evaluation may contribute to lower patient satisfaction among Asians.

Methods: From July 2014 to August 2015 we conducted a comparative mixed-methods study with Chinese, South Asian and NHW patients from a large multispecialty clinic in Northern California. Electronic health records were used to select patients for recruitment, and invitations were sent via letter, phone and/or email. Chinese patients include those whose preferred language was Mandarin, Cantonese or English. As English is widely spoken among the South Asian patient population, these patients were screened for acculturation at recruitment to include equal numbers of high- and low-acculturation patients. Patients participated in either a focus group or cognitive interview, and all participants completed surveys including demographics and standardized measures of acculturation, health care expectations and satisfaction. Focus group participants discussed their expectations and experiences of care, while cognitive interview participants shared the cognitive processes underlying their evaluation of a standardized health care visit vignette. Focus groups and surveys for Chinese patients were conducted in their preferred language. All cognitive interviews were conducted in English.

Results: We conducted focus groups with 58 Chinese (21 English-, 21 Mandarin-, and 16 Cantonese-speaking), 27 South Asian (14 high and 13 low acculturation) and 12 NHW patients, and cognitive interviews with 11 Chinese, 13 South Asian and 10 NHW patients (total N = 131). A comparative mixed-methods analysis is currently underway, employing descriptive and bivariate statistics and an integrated deductive and inductive thematic analysis. Results will compare subgroups of Asian and NHW patients in terms of: 1) expectations and experiences with health care, and 2) cognitive processes underlying evaluation of health care experiences.

Conclusion: Pending results will provide a comparative examination of differences between Asian and NHW patients’ reported satisfaction with care and the factors underlying these differences.




June 27th, 2016


August 12th, 2016