Discrimination and mental health of older Korean adults in the U.S.: Feasibility and preliminary efficacy of a culturally tailored mindfulness-positive psychological intervention using virtual reality

Hate crimes in the U.S. targeting adults of Asian descent have sharply increased during the COVID-19 pandemic. Although total hate crimes decreased by 6%, hate crimes against Asians increased by 189% across 16 major U.S. cities in 2021 (Center for the Study of Hate and Extremism, 2021), largely targeting vulnerable populations (e.g., older adults). Hate crimes and microaggressions during the pandemic are described by Asian Americans as leading to internalized stigmatization of the virus: "People look at me [Asian American] like I AM the [COVID-19] virus" (S. Choi, 2021). Given the internalized stigmatization, Asian Americans report feeling more threatened and fearful of experiencing anti-Asian racism versus actually contracting the COVID-19 virus and associated sequela (Rodriguez & McDede, 2021). No doubt, Asian Americans are experiencing elevated levels of psychological distress, fear, and anxiety due to racism stemming from and exacerbated by the pandemic. The Korean population in the U.S. is comprised of two-million individuals, and they tend to have high rates of exposure to anti-Asian hate crimes during the COVID-19 pandemic (Council of Korean Americans, 2021). Perceived racism is linked to detrimental profiles of mental health (e.g., depression, anxiety, and chronic stress) among older Korean Americans (Chau et al., 2018). However, older Korean Americans are likely to experience barriers to mental healthcare services largely due to demographic factors (i.e., insurance status, generational status, marital status, and gender; Spencer et al., 2010), English proficiency (D. Nguyen & Bornheimer, 2014), and cultural factors (e.g., stigma and acculturation; Han & Pong, 2015). In addition, older Korean Americans living in community areas with low Asian American density suffer from disparities in access to healthcare services due to a lack of culturally and linguistically appropriate services, including inadequate access to mental health professionals and community-based programs (S. Lee, 2020). Given the barriers to mental healthcare services for older Korean Americans, there remains a critical need to identify practical, well-accepted, culturally tailored, and sustainable individualized therapeutic strategies to alleviate adverse mental health profiles in older Korean Americans with perceived discrimination during the pandemic. This dissertation explored the prevalence of anti-Asian racism in older Korean Americans and immigrants during the COVID-19 pandemic. Moreover, it examined the feasibility, acceptability, and preliminary efficacy of the culturally-tailored mindfulness positive psychological intervention using virtual reality for older Korean Americans and immigrants living in the Chicago and Urbana-Champaign areas. This dissertation study used a concurrent mixed methods design that simultaneously collects qualitative and quantitative data, which coalesces strengths that reduce the disadvantage of a single method. A focus group (N = 18) qualitatively explored perceived anti-Asian racism during the pandemic. Furthermore, 32 participants with discrimination-related stress were enrolled in a randomized controlled trial of the culturally-tailored mindfulness-positive psychological intervention for three weeks (four modules), but one participant dropped out due to severe dizziness after the first virtual reality experience. There were no significant differences between the intervention group (N = 15) and the waitlist control group (N = 16) when it comes to socio-demographic, discrimination experiences, and psychological well-being variables. The mean scores of negative mental health in the intervention group decreased perceived stress, anxiety, and depression at post-intervention assessment. In addition, the mean scores of positive psychological well-being increased positive affect, life engagement, and mindful attention awareness at post-intervention assessment. However, there were no significant changes among those in the waitlist control group. Regression analyses in Model 1 indicated that participants in the intervention group showed a decrease in discrimination-related stress and perceived stress and an increase in positive affect, life engagement, and mindful attention awareness when compared to those in the waitlist control group. Model 2, adjusting for socio-demographic characteristics, indicated that older Korean participants in the intervention group showed a decrease in discrimination-related stress and perceived stress and an increase in life engagement when compared to those in the waitlist control group. Regarding intention-to-treat analysis via multiple imputations, there were no significant changes. Three significant findings from this dissertation study highlight that: 1) older Korean Americans and immigrants suffer from discrimination-related stress during the pandemic, 2) this dissertation study identifies the feasibility and acceptability of the culturally-tailored mindfulness positive psychological intervention for older Korean Americans and immigrants, and 3) the trial shows the beneficial effects on ameliorating discrimination-related stress and enhancing positive psychological well-being in older Korean Americans and immigrants. Given these results, this study builds empirical knowledge of previous research on discrimination and technology-based interventions for older adults. This dissertation study identifies the potential for utilizing technology to deliver effective psychological intervention for older minority immigrants with discrimination-related stress. In order to minimize mental health disparities among minorities in the U.S., social welfare policies could help facilitate the integration of technology (e.g., head-mounted displays, smartphones or tablets, web-based, and audio-based applications) into healthcare practices via collaboration and partnerships with healthcare providers in the future.

Name thesis:degree_name

Ph.D.

Level thesis:degree_level

Dissertation

Discipline thesis:degree_discipline

Social Work

Grantor

University of Illinois at Urbana-Champaign

Year dc:date

2023

Author dc:creator

• Kwon, Soonhyung

Contributors dc:contributor

• Wu, Chi-Fang
• Hernandez, Rosalba
• Ostler, Teresa
• Andrade, Flavia
• Gothe, Neha

• Virtual Reality
• Older Korean Americans
• Positive Psychology
• Anti Asian Racism
• Discrimination-related Stress

Statement dc:rights

• Copyright 2023 Soonhyung Kwon

Language dc:language

en, eng

Handle dc:identifier

https://hdl.handle.net/2142/121319

OAI record oai:identifier

https://www.ideals.illinois.edu/oai-pmh?verb=GetRecord&metadataPrefix=etdms&identifier=oai%3Awww.ideals.illinois.edu%3A2142%2F121319