Community and Generational Differences
Finally, there is the area of community. You may not know this, but two thirds of Asian Americans are born overseas. The history of Asian American immigration dates back to the 1800s, but the largest proportion of immigrants came to the United States in recent years. That means that they have a unique family structure.
Although they may be comfortable with the English language, English may not be the preferred language in the family structure. First-generation immigrants are very different from second-generation immigrants in the culture with respect to US society. Your approach to medications and the resources that patients draw from their community in terms of diabetes knowledge may be very different in first generations vs second generations. This is true not only in the Asian American community, but also for most immigrant cultures. In the Latino population, the Mexican population, and all other Hispanic populations, there are strong differences in the degree of acculturation, comfort level with diabetes, health literacy, linguistic abilities, how they process information, and how they relate to their family.
A group of individuals within the family structure who are quite important in the Asian American community is called the "sandwich generation." These people have elderly parents who may or may not speak English, and they have children of their own. They are caught in the middle. They are the gateway of health information. They are the ones who are taking their parents to the doctors, and they are involved in making healthcare decisions within the family. One clinical strategy is to involve the sandwich generations in immigrant families to be able to effectively communicate with patients.