Therefore, the study findings cannot be generalised to all Chinese Americans with type 2 diabetes. Although the results of this Wortmannin study cannot be generalised to a larger population due to design limitations, research has shown that similar barriers such as low health literacy, linguistic issues and lack of insurance negatively affect Korean immigrants with type 2 diabetes in terms of obtaining preventive care and health information.28 Second, it was observed that the percentage of male participants in the current study was much higher than the female counterparts (62% and 38%, respectively). This phenomenon may be due to the fact that many female immigrants had to rely on transportation

support from family members; thus they were not able to join the study despite being invited. This sample may not be generalised to the immigrant population in California, as the ratio of male to female immigrants in 2010 and 2011 was almost 1:1.30 Third, it should also be acknowledged that personal barriers to accessing health information may vary among individuals. Some personal barriers (financial status, employment status, housing environment, etc.) were not investigated in this study. Thus, future research should further investigate these personal factors that may influence health literacy. Finally, the health literacy of participants in this study was not assessed. Therefore, it is uncertain whether participants had

varying levels of health literacy. A tool should be developed to measure health literacy among minorities. The commonly used functional

health literacy scales, such as the Test of Functional Health Literacy in Adults (TOFHLA) or the Rapid Estimate of Adult Literacy in Medicine (REALM), have been criticised for their limitations in the scope of measurement, which restrict the measures to functional health literacy only. Health literacy is a broad concept with multiple dimensions. Thus, measuring one dimension of health literacy (functional health literacy only) may not be appropriate. Using the framework as shown in figure 1 and making reference to CDC’s definition of health literacy, we Cilengitide propose to develop a health literacy scale using a 5-point Likert scale (1=strongly disagree and 5=strongly agree). Examples of item in this new health literacy scale are: (1) I feel unease asking healthcare professional questions; (2) I cannot get health information because no one helps me; (3) I seldom attend health talks because I am not invited; (4) I seldom attend health talks because no one offers me a free ride; and (5) I cannot obtain health information because the materials cannot be applied to my daily healthcare practice. The current study has provided groundwork for future research in health literacy issues in non-English-speaking populations in the USA. Research in this area deserves attention and support. Supplementary Material Author’s manuscript: Click here to view.(3.9M, pdf) Reviewer comments: Click here to view.