Journal of Migration and Health · Published 2026-01-01 · DOI 10.1016/j.jmh.2026.100406
Background: Chronic hepatitis B (CHB) is one of the most widespread liver diseases in the world and disproportionately affects Asian Americans, who are further impacted by the lower quality of life imposed by the infection. Limited English proficiency (LEP) and acculturative stress play an important role in the study of patients with CHB, but the interrelationships of LEP, acculturative stress, and health outcomes are not well studied in this population. This study aims to explore how acculturative stress mediates the relationship between LEP and health outcomes among Korean American patients with CHB. Methods: A total of 365 CHB patients completed the enrollment survey. SF-12v2 was used to measure physical and mental component summary scores (PCS-12, MCS-12). The Riverside Acculturative Stress Inventory (n = 15, alpha=0.89) measured acculturative stress. Linear regression analyses were conducted. For mediation analyses, structural equation modeling with full information maximum likelihood estimation method was used. The bias-corrected bootstrap confidence interval (CI) method for inferential tests of the indirect effects was also conducted in mediation analysis. Results: LEP was associated with higher acculturative stress (β=3.62, p<.01). LEP had a direct effect on physical health and no direct effect on mental health. Acculturative stress partially mediated the relationship between LEP and health outcomes (e.g., PCS-12, MCS-12). Discussion: This study indicates that acculturative stress plays an important role in mediating the relationship between LEP and both physical and mental health outcomes. Future studies will develop interventions to achieve better health outcomes by reducing acculturative stress in this population.
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