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access to ESHCS access to health American clinics apartment complex better English fluency better perceptions bilingual staff Boyle Chae clients and health clinic health communication correlation between access Correlations between English cultural degree of access Douglas Education in Korea EKIs elderly Asians elderly immigrants elderly Korean immigrants English fluency speaking English language fluency English-speaking health caregivers experiences family interpreters family members health care information health care providers health care services health care settings health care variables health services health status Hispanic Hyattsville interaction Korean and English Korean language Kreps language difference learning English length of residency level of English Likert-type scales mean score measuring nursing practice Muecke pacific island participants Perception of Health perceptions about health Persidsky positive health beliefs positive perceptions pretty quality of English-speaking quality of health reading and writing self-concept services and perception social subjects survey questionnaire Tabora U.S. Department unexpected directions Wallston