Date of Award

August 2022

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Public Health

First Advisor

Lance S Weinhardt

Committee Members

Paul Florsheim, Young Cho, Lucy Mkandawire-Valhmu, Peninnah Kako

Abstract

Background: Among the nearly 10 million older adult immigrants in the United States, most come from Mexico and speak Spanish. Moreover, in addition to the hundreds of thousands of Russian-speaking immigrants from the Former Soviet Union already residing in the United States, the current war in Ukraine is fueling mass emigration of Ukrainian and Russian-speakers from Ukraine. Thus, in this study we sought to examine the health-impacting experiences of older adult Russian and Spanish-speaking immigrants in Southeastern Wisconsin. Design & Methods: This was a Community-Engaged Participatory Narrative Inquiry Photovoice Project and applied the Older Adult Immigrant Adapted Model for Health Promotion. Participants took or selected 10 photos, and then through an in-depth semi-structured interview we discussed the stories and experiences related to the photos, and how those experiences were related to their health. Moreover, given the multiple languages in this study, we created adapted cross-language research methods, which we followed in this study. These adapted cross-language methods were: (1) What and why? Considerations for Study Design, (2) When do we translate, and how many times? Question development, pilot testing, transcription, and translation, (3) Who? The role of the translator/interpreter during the research process, (4) Who again? Translator/interpreter credentials and positionality, (5) What are you really saying? Dynamic equivalence, (6) Do your ears deceive you? Reflexive reflective reflexivity, and (7) Triality, not just Duality, of the role of the Researcher. Data analysis was conducted in the languages of participants (Russian or Spanish). Data analysis was conducted by the research team to understand the metastory. Data analysis was an iterative process of listening and re-listening to interviews, as connected with the photos, assessing not only what was said, but how it was said. Results: The two overarching metastories were related to the environment and healthcare access. In this dissertation, the two sections of results are titled as follows: (1) “Your soul will rest in the fresh air” HealthInfluencing Experiences of Older Adult Russian and Spanish-Speaking Immigrants in Southeastern, Wisconsin, United States, and (2) “You Die or You Get Better” Conceptualizations of Health-Seeking Behavior and Health Care Encounters among Older Adult (Im)migrants in Wisconsin, the United States. These results demonstrate the importance of the environment as both facilitating and inhibiting the health of older adult Russian and Spanishspeaking immigrants. For example, social support, as well as access to parks and lakes positively affected participants physical and mental health, while limited access to health care negatively affected their physical and mental health. Significance: This study elucidated the experiences of older adult Russian and Spanish-speaking immigrants in Southeastern Wisconsin and explicates their own viewpoints through the use of their own photos. These findings underscore the importance of the built environment as it impacts health. They also underscore the importance of improved cross-cultural training for health care and public health professionals. Finally, these findings are novel and nuanced in that through the use of the Older Adult Adapted Model for Health Promotion the results illustrated the specific pathways that interact among older adult immigrants and thereby also illuminate potential areas for intervention.

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