Variability in Health Literacy and Learning Preferences on Peripheral Arterial Disease Among Chinese-speaking Communities in California

Technical Summary: Variability in Health Literacy and Learning Preferences on Peripheral Arterial Disease Among Chinese-speaking Communities in California

Problem Statement
Peripheral Arterial Disease (PAD) is a prevalent condition affecting over 12 million Americans, serving as a leading cause of lower extremity amputation and associated with high long-term mortality. Despite the critical nature of PAD, public awareness remains significantly lower compared to other cardiovascular conditions like stroke and heart disease. This deficit is particularly acute in minoritized populations, specifically Chinese-speaking communities in the United States, where health literacy gaps correlate with increased hospitalizations, emergency care usage, and poorer health outcomes. While previous research has identified knowledge gaps in San Francisco's Chinatown, there is a lack of data regarding how these disparities and learning preferences vary across different Chinese-speaking metropolitan communities within California.

Methodology
The study employed a cross-sectional survey design to assess baseline PAD knowledge and preferred media channels for health information.

• Data Collection: An anonymous, 14-question survey was administered in both Mandarin and English at health fairs in three distinct locations: San Francisco (SF), Oakland, and Los Angeles (LA). Data collection occurred between May 2023 and November 2024.
• Participants: The study collected 180 responses (SF: 94, Oakland: 57, LA: 29). For respondents unable to read the survey, trained volunteers or certified translators recorded responses.
• Variables: Key demographic variables included age (categorized as <65 vs. ≥65), sex, education level, English proficiency, and primary language. The survey measured prior awareness of PAD, familiarity with risk factors, and preferred methods for receiving health information (e.g., radio, video, internet, newspapers).
• Statistical Analysis: Chi-squared analyses were used to compare demographics and media preferences between cohorts, using the SF cohort as a reference group based on prior literature. ANOVA and logistic regression were utilized to assess associations between learning preferences and demographic factors. Significance was set at p < 0.05.

Key Results

• PAD Awareness: Awareness of PAD was consistently low across all three cohorts. Only 28% of the total pooled sample had heard of PAD previously. There were no statistically significant differences in awareness levels between the SF, Oakland, and LA cohorts (p > 0.05). Similarly, familiarity with PAD risk factors was low and did not differ significantly by location.
• Demographic Variations: The SF cohort had a significantly higher proportion of participants aged 65 and older (85%) compared to Oakland (68%) (p = 0.018). English proficiency varied significantly across sites; the LA cohort had the lowest proficiency (7% proficient), while Oakland had the highest (39% proficient).
• Learning Preferences:
  • San Francisco: Participants strongly preferred radio (52%) as a top method for receiving health information.
  • Oakland: Participants significantly favored video/media (32%) over radio (19%) (p = 0.024 compared to SF).
  • Los Angeles: Preferences aligned more closely with SF regarding radio (28%), though sample sizes were smaller.
  • General Media: SF and LA cohorts showed stronger preferences for traditional media (newspapers and television), whereas the Oakland cohort favored video.
• Demographic Correlates: Preferences were heavily influenced by age and education. Older participants (65+) and those with lower English proficiency or education levels tended to prefer traditional channels like radio and newspapers. Conversely, younger participants and those with higher education/English proficiency in Oakland showed a marked preference for digital formats (video, internet-based learning).

Key Contributions

• Comparative Analysis: This is the first study to survey multiple Chinese-speaking communities across different US metropolitan areas to assess PAD knowledge and learning preferences simultaneously.
• Identification of Heterogeneity: The study demonstrates that even within a single ethnic group sharing a common language and cultural background, significant variations exist in health literacy and media consumption habits based on local demographics (age, education, English proficiency).
• Data-Driven Strategy: The findings provide empirical evidence that a "one-size-fits-all" approach to health education is ineffective. The study identifies specific media channels (radio vs. video) that are statistically significant for specific sub-communities.

Significance and Claims
The paper claims that its findings underscore the necessity of culturally and community-based health education strategies. The authors argue that while PAD awareness is uniformly poor across the surveyed Chinese-speaking populations, the method of delivering education must be tailored to the specific demographic profile of each community.

• Tailored Outreach: The study suggests that interventions for older, less English-proficient populations (like those in SF and parts of LA) should leverage traditional media (radio, newspapers), while younger or more educated demographics (like those in Oakland) may respond better to digital and video-based content.
• Foundation for Future Work: The authors position this study as a foundational step to lay the groundwork for larger, multi-lingual, and multimedia educational tools. They assert that understanding these nuances is essential for improving patient engagement, reducing PAD-related complications, and addressing disparities in vascular health outcomes.
• Limitations: The authors modestly acknowledge limitations, including potential selection bias from surveying health fairs, the cross-sectional nature of the study preventing causal inference, and the lack of data on non-participants. They note that the findings may not generalize to all Chinese-speaking communities outside of Chinatown health fairs.