Health literacy and patient engagement among Korean immigrants in the U.S.: exploring the emotional, cognitive, and behavioral dimensions

Introduction While patient engagement is central to the Western model of healthcare, behavior-focused models limit understanding of how health literacy shapes patient engagement in emotional and cognitive dimensions among immigrants. This mixed-method study aims to examine the relationship between health literacy and patient engagement across behavioral, emotional, and cognitive dimensions among Korean immigrants in the U.S. Methods In an explanatory sequential mixed-method design, an online survey ( N = 105) and semi-structured interviews ( N = 20) were conducted to test the hypothesis and to explore the research question. Results In the quantitative phase, MANCOVA and multiple regression analysis results demonstrated that when English proficiency is controlled for, health literacy is associated with the behavioral and cognitive but not the emotional dimension of patient engagement. Qualitative data supported and complemented these findings, revealing that feelings such as frustrations were commonly found regardless of health literacy levels, whereas higher health literacy seemed to enable participants to enact their cognitive beliefs about patient engagement behaviorally. Conclusion Patient engagement among Korean immigrants in the U.S. is a subjective experience encompassing behavioral, cognitive, and emotional dimensions. This study highlights the need for a comprehensive conceptual framework for patient engagement among immigrant populations.