Acculturation and Its Influence on the Health Perceptionsy Health Behaviors, and Health Outcomes of African Immigrants in the United States: A Review of the Literature

INTRODUCTIONAcculturation, a process that occurs "when groups of different cultural backgrounds and their individual members engage each other," is said to influence health out-comes and patterns of health care service utilization among certain groups of immigrants in the United States (i.e., Asian-Americans, Hispanic immigrants) (Berry, 2008; Estrada, Trevino, and Ray, 1990; Gordon-Larsen et al., 2003; Lara et al., 2005; Lee, Sobal, and Frongillo Jr., 2000; Salant and Lauderdale, 2003). African-born immigrants who are largely invisible in the vast literature on immigrant health in the United States (US), have doubled in size from 881,300 in 2000 to 1.6 million in 2010 (Ndukwe, Williams, and Sheppard, 2013), yet it is not well understood whether acculturation has an effect on their health perceptions, health outcomes, or patterns of health care utilization. Evidence suggests that being born in another country versus being born in the US influences one's use of health care services and health outcomes (Mullins et al., 2010; Wafula and Snipes, 2013). African immigrants are usually lumped into the same category as African Americans and Caribbeans. Indeed, African immigrants in the US have unique health needs that are different from other black immigrant populations in the US. Challenges such as lack of health insurance, lack of interpreters, discrimination based on race or access, and lack of understanding on the part of health care providers regarding African perspectives (such as mystical powers as disease causing agents) of illness, all play a significant role in their perceptions of health, health behaviors, and health outcomes (Wafula and Snipes, 2013). Given that the African immigrant population in the US is projected to increase well into the foreseeable future (Venters and Gany, 2011) the effect of acculmration on their health is a pertinent issue that warrants further exploration.A major contributor to the smdy of acculmration is found in Berry's (1997) concepmal analysis of acculmration attitudes, which argues that there are two fundamental dimensions of acculmration: maintenance of original culmral identity and maintenance of relation with other groups. This bidimensional model leads to four acculmration strategies classified as assimilation, separation, integration and marginalization (Berry, 1997). While assimilation involves giving up one's culmral identity and increasing daily interaction with other cultures, separation constitutes maintenance of original culmral identity while avoiding interactions with others (Barry, 2001; Berry 1997). With integration, culmral identity is maintained while simultaneously becoming an integral part of the larger society, but with marginalization there is no culmral or psychological contact with their culmre of origin or the larger society (Barry, 2001; Berry, 1997). Although Berry's model is widely recognized as exerting a prominent influence on acculmration, critiques of the model suggest that it is exclusively based on attitudes toward culmral orientations which do not necessarily correspond to behavior (Kang, 2006). Moreover prior research suggests that the model fails to assess language behavior (Kang, 2006) which could be a secondary, yet dominant way of measuring, for example, how African-born immigrants with their deep culmral ties immerse themselves in the mainstream culmre while navigating issues related to health (Kang, 2006). There is no one standard measure of acculmration; however, there are proxy measures used to operationalize acculmration within different contexts. In addition to Berry's model, information on nativity (birthplace), duration of time in the US, English language usage, age at immigration, and language spoken at home are the commonly used proxy measures of the relationship between acculmration and health outcomes in immigrant populations (Cabassa, 2003). The basic assumption with these proxy measures is that acculmration can be inferred from the amount of exposure individuals have to the dominant culmre, and it, in mrn, influences how they adapt to their new environment (Cabassa, 2003). …