The limited research into Vietnamese immigrants suggests that this group may have different perceptions relating to parenting roles, child development, child health, illness, and disability, and differing patterns of health service utilisation. The author conducted a pilot study exploring how Vietnamese immigrants differ from Anglo-Australian in relation to these issues. The pilot, utilising a mixed quantitative and qualitative method, was conducted in Brisbane, Australia, with subjects being existing clients of a health centre. Two focus group discussions were conducted and a structured questionnaire developed from the discussions. Vietnamese immigrants in contrast to Australian-born Caucasians regard the general practitioner as the main health care provider and were less satisfied with English-speaking health services. This study highlights potentially important health-related issues for children of Vietnamese immigrants living in Brisbane, the importance of further research in this area, and the methodological challenges faced when conducting research into Vietnamese immigrants.
The literature indicates reduced access to health services and disparate health outcomes in people from culturally and linguistically diverse backgrounds (CLDBs) living in Western countries [
With Australia’s increasingly cultural and linguistically diverse society, in particular a growing Asian population, health outcomes and health service utilisation of this population is an issue of great relevance to Australian practitioners and policy-makers. Even though commonalities may exist between CLDB populations, further exploration regarding poor health outcomes and access to health services demonstrate the importance of specific factors that are unique to individual communities.
During this study, staff at Inala Community Health’s Department of Child, Youth and Family Health indicated possible deficits in the delivery of health services to families from CLDB, especially those from a Vietnamese background. Staff believed that these deficits may be related to different cultural perceptions held by parents about children’s health, development, and the role of parenting. A greater understanding of cultural values and beliefs of people from CLDB, which underlie health behaviour, is essential if appropriate health services are to be provided.
A significant amount of the immigrant health research emanates from the United States of America, where health insurance status is often a major influencing factor in health access and service utilisation [
There have been few Australian studies which have explored health concerns and barriers to accessing health services amongst Vietnamese immigrants [
Traditional cultural health beliefs and practices are often incongruent with those of Western society and may pose a barrier to accessing health services [
Thus this study and paper aims to contribute to the limited knowledge about Vietnamese immigrants living in Australia, their perceptions regarding their parenting roles, and the health and development of their children and their utilisation of health services for their children.
Prior to commencement of the study the following hypotheses were proposed. Vietnamese immigrant parents living in Brisbane have different perceptions about parenting roles and child health, illness, disability, discipline, behaviour, and child health services, compared with Australian-born Caucasian parents. Vietnamese immigrant parents living in Brisbane underutilise child health services, have less knowledge of them, are less able to access them, and are less satisfied with those they have used compared with Australian-born Caucasian parents.
This is an exploratory study that utilised mixed methods of data collection, both quantitative (structured questionnaire) and qualitative (focus group) methodology. The focus groups were conducted first and responses were then used to inform issues to explore further in the questionnaire. For the purpose of this paper, the study group or participants will be referred to as the Vietnamese group or participants and the comparison group referred to as the Australian group or participants.
The study was conducted in Inala, Queensland in 2002. Inala is a suburb in the south-western outskirts of Brisbane. It is a low socioeconomic area with a culturally and linguistically diverse population and houses many recent immigrants [
All subjects were existing clients of the Inala Community Health Centre. Inclusion criteria were adults over the age of 18 years, who lived in the Inala and surrounding area, gave informed consent, and had at least one child under the age of 5 years. The Vietnamese participants were first generation Vietnamese immigrants and the Australian group were Australian-born Caucasian. People from other cultural backgrounds were excluded to maintain cultural homogeneity. Exclusion criteria were known mental illness or intellectual disability in the adult subjects. The focus group and questionnaire participants were all existing clients of the Inala Community Health Centre. As this was a pilot and the intention is to follow-up with a full study, convenience sampling was used.
There were two focus groups, one with five Vietnamese immigrant parents and the other with nine Australian-born Caucasian parents. The chief investigator, who is bilingual in English and Vietnamese, and a child health nurse, facilitated both focus groups. A Vietnamese Liaison Officer was also present during the Vietnamese focus group.
The questionnaire was developed by the Principal investigator using a well-accepted process described in the literature [
A pilot questionnaire was critically reviewed by a panel of paediatricians and professionals who work with the Vietnamese community to assess the questions for relevance. Professionals working with the Vietnamese community consisted of staff at the Inala Community health Centre as well as a Vietnamese general practitioner and a Vietnamese counsellor. The two native Vietnamese speakers, who are fluent in English, were asked to examine the questions for their ease of translation. Once the reliability of the questions had been confirmed, a qualified translator was asked to translate the questions into Vietnamese. They were then back translated into English for confirmation of meaning and equivalence [
The questionnaire was pretested by a small number of Vietnamese-born and Caucasian Australian-born parents to examine for content validity, ease of use, and relevance. The same panel of parents repeated the questionnaires two weeks later to examine retest reliability. The results were compared using correlation coefficients. The results from both the Australian and Vietnamese groups possessed high test-retest reliability, with a combined correlation coefficient of 84% (Pearson’s) and 97.5% (Spearman’s). Second attempt score did not vary more than 8% different from first scores for each individual. The individual questions were also examined and were deemed to be answered consistently the second time compared with the first time.
The final questionnaire was administered to the Vietnamese and Australian study groups. The Vietnamese group were given the choice of the Vietnamese or English version, with all but one person choosing the Vietnamese version. There was one designated data collector for each group: a child health nurse for the Australian group and a Vietnamese Liaison Officer for the Vietnamese group. Although the questionnaires were self-administered, the designated data collectors were on hand to clarify any questions. The Vietnamese Liaison Officer, who is a qualified interpreter, assisted in interpreting the open-ended questions and vignettes in a culturally appropriate way and translating the data into English.
All information, consent forms, and the questionnaire were translated into Vietnamese by a qualified Vietnamese language translator and then back translated for accuracy. This is a methodologically sound and well-accepted approach in cross-cultural research [
The Vietnamese focus group participants were selected from parents attending the Community Centre’s Bacillus-Calmette-Guerin (BCG) Immunisation Clinic. They were approached by the Vietnamese liaison officer and gave verbal consent to participate in the focus group discussions. The Australian focus group participants were primarily parents who attended the Centre’s parenting groups and baby clinics, who verbally agreed to participate in the focus group discussions.
In recruiting participants for the questionnaire (See Supplementary Material available online at doi:10.1155/2012/932364), existing clients of Inala Community Health Centre’s immunisation clinics, child health clinics, and parenting groups, with children between 0 and 5 years of age, were directly approached by the Centre’s child health nurses and/or the Vietnamese Liaison Officer. The majority of the Vietnamese-born participants were clients attending the BCG immunisation clinics and the rest were clients of the Home Visiting Program. The participants were given an information sheet, either in English or Vietnamese, outlining the details and purpose of the study.
While there is some power gradient involved, as the parents are clients of the child health nurses and the interpreter, the nonthreatening nature of the study was explained. Using a Vietnamese recruiter helped to reduce the power gradient [
The focus group discussions were not taped because the literature indicates that this is not well accepted by Vietnamese women [
The questionnaire responses were entered into SPSS and descriptive statistics generated. The two study groups were examined in terms of demographic variables, utilisation of health services, satisfaction with health services, and understanding and perception of health professionals roles, common issues in child development and health, and causation of childhood conditions. For continuous variables one-way analysis of variance (ANOVA) and the Chi-squared tests for categoric variables were used.
Due to the small number of study participants, some of the variables were recoded with categories collapsed together. Frequency distribution curves were studied to determine which categories were to be collapsed together.
The main findings are summarised in Table
Focus group findings.
Issue | Vietnamese | Australian |
---|---|---|
Health Services | Primarily GP1 | Use community health services and GP |
Satisfied with GP | Less satisfied with GP | |
Difficulty accessing community health services because of transportation problems; want home visits | Want community centres to run fathers’ groups | |
Roles of health professionals | Understood roles of GP, and paediatrician | Understood roles of GP, paediatrician, CHN2, PT3 |
Confused roles of psychologist and psychiatrist | Confused roles of psychologist and psychiatrist | |
Did not know roles of PT, OT4, SLP5, CHN, and SW6 | Did not know roles of OT, SLP, and SW | |
Child Development | Offered child(ren) variety of toys | Emphasis on educational toys |
Solid food introduced same time as Caucasian group | ||
Allowed child to feed independently later for fear of mess | ||
Parenting | Preferred explanation for discipline rather than spanking | Mostly infants so discipline not as relevant |
Causation of chronic medical conditions, and disabilities | ||
Asthma | Cold, wind, allergies | Genetics, environment, grass, sand |
Mental Illness | Trauma, use of OCP7, previous abortion, Karma | Genetics, stress |
Epilepsy | Don’t know | Genetics, trauma, drugs |
ADHD8 | Don’t know | Social factors, parenting, foods, preservatives |
CP9 | Don’t know | Genetics, inutero problems, vitamin deficiencies |
1General Practitioner, 2Community Health Nurse, 3Physiotherapist, 4Occupational therapist, 5Speech and Language Pathologist, 6Social Worker, 7Oral contraceptive pill, 8Attention deficit hyperactivity syndrome, 9Cerebral Palsy.
The questionnaire completion rate varied depending on the questions. The Vietnamese participants tended to leave questions blank if they did not know the answer or completed some of the questions about satisfaction with health services incorrectly, that is, attempted to answer question about a service they had not used.
Table
Demographics of questionnaire participants.
Variable | Vietnamese | Australian | |
---|---|---|---|
Role | |||
Mother | 12 (100) | 10 (100) | — |
Father | 0 (0) | 0 (0) | |
| 12 (100) | 10 (100) | |
Age of parent (years) | |||
Responders (%) | 12 (100) | 10 (100) | .16 |
<30 | 6 (50) | 2 (20) | |
≥30 | 6 (50) | 8 (80) | |
| 12 (100) | 10 (100) | |
Years in Australia (mean, SD) | 6.5 (3.14) | Born here | |
| 12 (100) | 10 (100) | |
Marital status | |||
Married/Common-Law | 8 (80) | 9 (90) | .53 |
Other | 2 (20) | 1 (10) | |
| 10 (83.3) | 10 (100) | |
Number of children (mean, SD) | 1.83 (0.72) | 2.70 (0.95) | .024 |
| 12 (100) | 10 (100) | |
Age children (mean, SD) | 2.13 (2.13) | 3.75 (1.33) | .05 |
| 12 (100) | 10 (100) | |
Income2 | |||
Low (<$20,000) | 3 (60) | 1 (11.1) | .09 |
Middle ($20,000–$29,000) | 0 (0) | 4 (44.4) | |
High (>$30,000) | 2 (40) | 4 (44.4) | |
| 5 (41.6) | 9 (90) | |
Level of education | |||
Some secondary | 3 (27.3) | 4 (40) | .66 |
Completed secondary | 8 (72.7) | 6 (60) | |
| 11 (91.6) | 10 (100) | |
Occupation | |||
Home duties | 10 (90.9) | 10(100) | .52 |
Fulltime work | 1 (9.1) | 0 (0) | |
| 11 (91.6) | 10 (100) |
1One participant recruited was excluded from study analysis as it did not meet eligibility criteria.
2Based on Australian Bureau of Statistics Data
More than half of the Vietnamese participants did not respond to the income question, but of those who responded, 60% had incomes below $20,000 a year compared to only 11.1% of the Australian group, although this difference was not statistically significant.
41.7% of the Vietnamese participants had lived in Australia for at least nine years, with the mean years in Australian 6.5 (SD 3.14), but most participants only rated their spoken English ability and understanding and ability to read English as “all right” or “very little or not at all”.
Tables
Utilisation of health services by questionnaire participants.
Services used—sometimes/often | Vietnamese | Australian | |
---|---|---|---|
General Practitioner | |||
| 12 (100) | 10 (100) | — |
| 12 (100) | 10 (100) | |
Hospital | |||
| 9 (90) | 8 (80) | .50 |
| 10 (83.3) | 10 (100) | |
Community Health Centre | |||
| 10 (83.3) | 10 (100) | .50 |
| 10 (100) | 10 (100) | |
Medical Specialist | |||
| 8 (66.7) | 8 (80) | .42 |
| 12 (100) | 10 (100) | |
Health Professional | |||
| 8 (80) | 8 (66.7) | .42 |
| 12 (100) | 10 (100) | |
Therapist | |||
| 1 (9.1) | 7 (70) | .007 |
| 11 (91.7) | 10 (100) | |
Alternative Practitioner | |||
| 12 (100) | 10 (100) | .41 |
| 2 (16.7) | 3 (30) |
Use of services at inala community health centre.
Services used | Vietnamese | Caucasian | |
---|---|---|---|
Information seminars | 0 | 4 (40) | .03 |
Parent information groups | 0 | 2 (20) | .20 |
Home visits | 6 (50) | 5 (50) | .67 |
Triple P (Parenting workshops) | 0 | 3 (30) | .08 |
Immunisation clinics | 9 (75) | 5 (50) | .22 |
Infant Feeding Clinic | 1 (8.2) | 1 (10) | .71 |
Therapy (PT, OT, SLP) | 0 | 5 (50) | .01 |
Paediatrician clinic | 1 (8.2) | 4 (40) | .11 |
CYMHS1 | 2 (16.7) | 1 (10) | .57 |
Antenatal clinic | 4 (33.3) | 7 (70) | .10 |
Day management | 1 (8.3) | 2 (20) | .43 |
Other | 0 | 1 (10) | .46 |
1Child, Youth, and Mental Health Services.
Table
Satisfaction with health services used.
Services used | Mean (SD) [Respondents (%)] | ||
Vietnamese | Australian | ||
GP | 4.45 (0.69) | 4.47 (0.49) | .94 |
[12 (100)] | [10 (100)] | ||
Hospital | 4.41 (0.72) | 4.83 (0.29) | .14 |
[12 (100)] | [8 (80)] | ||
Com Health Cent | 4.50 (0.70) | 4.72 (0.44) | .42 |
[12 (100)] | [9 (90)] | ||
Medical Specialist | 4.03 (0.80) | 4.68 (0.77) | .14 |
[6 (50)] | [9 (90)] | ||
Health Professional | 4.16 (0.83) | 4.81 (0.30) | .065 |
[5 (41.6)] | [8 (80)] | ||
Therapist | 4.00 (0.00) | 4.84 (0.42) | .029 |
[2 (16.7)] | [7 (70)] | ||
Alternative Practitioner | 4.33 (0.58) | 4.67 (0.58) | .52 |
[3 (25)] | [3 (30)] |
The Vietnamese group were less positive about medical specialists, although this was not statistically significant. The Vietnamese group rated other health professionals (dentists, optometrists) less positively than the Australian group with the difference almost reaching statistical significance (
Table
Satisfaction with community child health services used.
Services used | Mean (SD) (Respondents (%)) | ||
Vietnamese | Australian | ||
Home Visiting | 4.67 (0.52) | 4.33 (0.82) | .27 |
[6 (50)] | [6 (60)] | ||
Immunisation Clinic | 4.75 (0.46) | 4.67 (0.82) | .41 |
[8 (66.67)] | [6 (60)] | ||
Feeding | 5.00 (0.00) | 5.00 (0.00) | — |
[1 (8.33)] | [3 (30)] | ||
Paediatrician | 5.00 (0.00) | 5.00 (0.00) | — |
[1 (8.33)] | [3 (30)] | ||
CYMHS | 5.00 (0.00) | 4.00 (0.00) | 0.5 |
[1 (8.33)] | [1 (10)] | ||
Antenatal | 4.75 (0.500) | 4.86 (0.38) | .45 |
[4 (30)] | [7 (70)] |
Table
Understanding of professionals’ roles.
Professional | Partially/fully correct | ||
Vietnamese | Australian | ||
Physiotherapist | 2 (33.3) | 9 (90) | .036 |
6 (50) | 11 (100) | ||
Speech Pathologist | 2 (33.3) | 10 (100) | .008 |
6 (50) | 10 (100) | ||
Occupational Therapist | 2 (33.3) | 7 (70) | .18 |
6 (50) | 10 (100) | ||
Psychologist | 2 (33.3) | 5 (50) | .45 |
6 (50) | 10 (100) | ||
Psychiatrist | 3 (42.9) | 5 (50) | .58 |
7 (58.3) | 10 (100) | ||
Community Health Nurse | 5 (71.4) | 7 (70) | .69 |
7 (58.3) | 10 (100) | ||
General Practitioner | 7 (70) | 9 (90) | .29 |
10 (83.3) | 10 (100) | ||
Paediatrician | 6 (75) | 9 (90) | .41 |
8 (66.6) | 10 (100) |
Table
Vignettes.
Vignette | Partially/fully correct | ||
Vietnamese | Australian | ||
Diarrhoea | 10 (90.9) | 10 (100) | .52 |
Picky eater | 5 (45.5) | 9 (90) | .043 |
Excessive milk | 9 (81.8) | 10 (100) | .26 |
Feeding | 7 (63.6) | 10 (100) | .06 |
Delayed walker | 3 (27.3) | 5 (50) | .27 |
Delayed language | 4 (40) | 6 (60) | .21 |
Tummy time | 7 (58.3) | 8 (80) | .27 |
Reading | 6 (54.5) | 10 (100) | .023 |
Cleanliness | 11 (100) | 10 (100) | .50 |
Tantrum | 10 (90.9) | 10 (100) | .52 |
Both groups had a high rate of partially or fully correct responses for the vignettes, but the vignettes about delayed walking and delayed speech and language produced the greatest rate of incorrect responses from both groups. The Vietnamese group were statistically difference from the Australian group, with more incorrect responses for the vignettes about picky eater, feeding, and reading/books. The majority of participants in the Vietnamese group answered that they would “buy more books for their child but let her decide what she wanted to play with”, for the vignette about reading and books. The majority of participants from both study group responded that they would “explain to their child that it was dinner time and it would be nice if she came”, for the tantrum vignette, with only one participant (Australian) responding that they would take the child to “quite time” (time out).
Table
Causes of conditions.
Condition | Cause | Vietnamese | Australian | |
---|---|---|---|---|
ADHD | Upbringing | 4 (44) | 0 | .029 |
Preservatives | 3 (27.3) | 6 (60) | .24 | |
Previous life | 0 | 0 | — | |
Genetics | 3 (27.3) | 8 (80) | .043 | |
8 (66.7) | 9 (90) | |||
Asthma | Genetics | 7 (63.6) | 10 (100) | .055 |
Catch it | 1 (9.1) | 0 | .52 | |
Preservatives | 0 | 2 (20) | .21 | |
Cold weather | 7 (64) | 4 (36) | .14 | |
11 (91.7) | 10 (100) | |||
CP | Genetics | 1 (9.1) | 8 (80) | .004 |
Diet | 3 (27.3) | 3 (30) | .19 | |
Birth trauma | 5 (62.5) | 3 (30) | .18 | |
Previous life | 1 (13) | 0 | .44 | |
8 (66.7) | 10 (100) | |||
Epilepsy | Previous life | 1 (11.1) | 0 | .47 |
Abortion | 0 | 0 | — | |
Head injury | 5 (56) | 6 (55) | .59 | |
Genetics | 5 (56) | 9 (82) | .26 | |
9 (75) | 10 (100) | |||
Mental illness | Previous life | 0 | 0 | .21 |
Genetics | 3 (25) | 9 (90) | .017 | |
Psychological trauma | 6 (66.7) | 8 (80) | .44 | |
Abortion | 2 (22.2) | 0 | .21 | |
9 (75) | 10 (100) |
This study has elicited important issues relating to Vietnamese immigrant and refugee parents’ perception of child health, development, and their utilisation of child health services, with the intention of further exploration of these issues with a subsequent full-scale study.
The main study findings and implications are summarised in Tables
Summary of main study findings.
Vietnamese participants compared with Australian participants |
---|
(1) Have different perceptions of early childhood development. |
(2) Stigmatise mental and physical conditions more. |
(3) Regard general practitioner as the primary as first point of call for children’s health issues. |
(4) Have little knowledge of available community child health services and do not tend to utilise these services apart from home visiting and antenatal services. |
(5) Have little knowledge of allied health professionals’ roles. |
(6) Are less satisfied with community health services they have had contact with previously. |
Implications of study findings.
(1) Structures questionnaire study methodology may not be appropriate for study type. |
(2) More qualitative methodology such as focus group discussions or unstructured interviews may be preferable. |
(3) Potential differences in perceptions of the Vietnamese and Australian parents regarding child development warrant further study. |
(4) Reasons for Vietnamese parents not accessing community child health services warrant further study. |
The majority of the Vietnamese study participants had Vietnamese family doctors, with whom they primarily consulted for issues relating to their children’s health. Very few were familiar with the services provided by the Community Health Centre, apart from the BCG Immunisation Clinic, antenatal clinic, and the Home Visiting Program. In Queensland infants with parents from an Asian background are offered BCG vaccine to protect them from contracting tuberculosis, and information about where to obtain immunisations is given to parents at the time of discharge from the maternity hospital. The Home Visiting Program at the time of this study was offered to all first-time mothers who requested the service or who were referred from the maternity hospital after giving birth.
The Vietnamese focus group participants expressed a wish for more home visiting services, to obtain assistance and advice about their infants’ feeding and sleeping. However, Vietnamese questionnaire participants were less familiar with the role health professionals such as therapists, social workers, and community nurses. This is not surprising, considering that these professional roles do not exist in the traditional Vietnamese health system. Vietnamese participants first consulted their relatives and then their Vietnamese family doctor, for child health-related problems. Many preferred to delay and see their general practitioner rather than attend a community health centre and utilise the services of an interpreter. The vast majority of questionnaire participants in both groups gave the response “never needed their service” as a reason for never using a particular health service. The rest gave reasons of “do not know about them” and “too expensive”, but nobody gave reasons of “transport problems”, “language”, “culture”, or any other reason. Of those who had utilised other health services (therapy services, paediatricians, dentists and optometrists) the Vietnamese participants were less satisfied than Australian participants.
Several Australian studies have explored health concerns and barriers to accessing health services in Vietnamese families and arrived at similar conclusions as our study [
Similar to the findings from this study, some studies found that Vietnamese-born immigrants expected from community health centres such services as home visiting, advice and information, health checks, and bilingual professionals [
Vietnamese people tend to define their health problems in terms of physical symptoms, including emotional or psychological disturbances, which avoids the stigmata of mental illness [
A study into Vietnamese-born parents’ oral health practices [
Australian research into use of children’s hospital services by families from culturally and linguistically diverse (CALD) backgrounds found that CALD families were very satisfied with their children’s care, though they also tended to not complain or express dissatisfaction for fear of repercussion or appearing to stand out [
Both Vietnamese and Australian questionnaire participants recognised when to seek medical attention for an acute illness and both groups understood principles of infant nutrition.
Whilst there was no difference between the age (around six months) at which participants in the two focus groups introduced solid foods, the Vietnamese focus group participants tended to delay independent feeding, preferring to wait until the child was old enough to “not make a mess” (around 2 years). This was also consistent with the result from the feeding vignette in the questionnaire, which only 63.6% of Vietnamese study participants answered correctly. The focus group discussions found that the Vietnamese participants tended to allow their children to play with any toys that they wanted, whereas the Australian participants bought what they perceived to be educational toys. This was also consistent with the result of the reading vignette in which there was a difference between the two groups in correct responses, with only 54.5% of the Vietnamese group responding that they would read more to their child, and the rest responding that they would buy more books but let the child play with what they wanted.
The Vietnamese questionnaire participants were less likely to encourage “tummy time” in play than the Australian participants. Tummy time refers to placing the infant in the prone position during play and is thought to be important in encouraging development of crucial weight bearing upper body and upper limb muscles and consequently gross motor skills, such as pushing up and crawling [
Research has examined differences in the way various cultures parent and how this may impact on the child’s development [
Research undertaken by Wise and colleagues for the AIFS has studied cultural variations in parenting beliefs and behaviours between Anglo-Australian parents, Vietnamese parents, and Somali parents [
Vietnamese-focus group participants tended to use “softer” methods of explaining rather than “time-out”. This is consistent with literature on more permissive and tolerant parenting of younger children in the Vietnamese culture [
Vietnamese focus group and questionnaire participants were more likely to attribute nonmedical rather than medical factors as being causative for medical and neurodevelopmental conditions such as ADHD, epilepsy, and CP. One Vietnamese questionnaire respondent perceived “what you did in a previous life” to be a cause of epilepsy and CP, and another person perceived that attempted abortion was a cause of mental illness in a mother. One Vietnamese focus group participant perceived that Karma, attempted abortion, and taking the oral contraceptive pill were also causes of mental illness in children. These findings are consistent with the current literature, which indicates that Asians living in Western countries tend to stigmatise disability and mental illness more than their Western counterparts [
Another Australian study, which explored parental perceptions of child psychopathology and disease causation, of Vietnamese parents living in Perth, found that the majority of parents (75.5% to 78.1%) thought that child mental illness was caused by biological/chemical imbalance in the brain, trauma or bad experiences, and a metaphysical or spiritual imbalance. 57.2% endorsed a genetic or hereditary cause, and 17.6% indicated karma as the cause of child mental illness.
One reason for Vietnamese immigrants’ more negative perception of mental illness may be the Confucian tradition of sacrificing individual needs to that of the overall group needs [
There are a number of possible explanations for conflicting findings from the Vietnamese focus group discussions and questionnaire. Firstly, there may be inherent differences in these two groups, which influence perceptions regarding these issues. Participants from both groups were mostly recruited from the Centre’s BCG Immunisation Clinic. However sociodemographic information about the focus group participants would have been helpful in comparing these two groups. The second explanation is measurement or information bias due to two different methodological approaches, thus eliciting different responses. Of note the questionnaire response rate in the Vietnamese group was only 7/12 compared with 11/11 for the Australian group. The literature on cross-cultural research supports this explanation by indicating that focus groups or face-to-face interviews may be a more effective data collection method than structured questionnaire, as they can foster trust and allow participants to describe their view and experiences in a context in which cultural nuances can be recognised [
There are limitations to this study, which may contribute to conflicting study findings. The main source of potential bias was differences in recruitment method for Vietnamese and Australian participants. The Vietnamese participants attended the BCG Immunisation clinic, whereas the Australian participants were attendants of the parents’ groups and baby clinics. This problem with recruitment was unavoidable, as no immunisation clinic exists for Caucasian Australian children at the Centre, and no existing Vietnamese clients utilised other services at the Centre.
Utilisation of an inappropriate data collection method, of a structured questionnaire, may have resulted in measurement bias as it does not give the flexibility to express views and perceptions fully and can misinterpret cultural nuances [
The majority of questionnaire participants both Vietnamese and Anglo-Australian were from a low sociodemographic background with no tertiary education and low income. The demographic profile of study participants is representative of Inala’s population [
However these findings cannot be generalizable to Anglo-Australian or Vietnamese parents from higher sociodemographic backgrounds. In addition although 50% of the Vietnamese questionnaire participants had been in Australia for eight years or more, most of them rated their spoken English ability and understanding and ability to read English as “all right” or “very little or not at all”. Thus the study results are not necessarily generalizable to Vietnamese immigrants who are more acculturated into Australian society.
Findings have highlighted issues relating to Vietnamese parents’ perceptions and beliefs regarding children’s health, illness, and development, as well as child health service utilisation, which have not yet been extensively studied in the past. Vietnamese parents in comparison to Anglo-Australian parents have a more collectivist view of child rearing and place less expectation on infants and young children to achieve independence. Vietnamese parents tend to attribute nonbiological or metaphysical causation such as Karma to mental illness or neurodevelopmental conditions such as epilepsy, ADHD, and CP. They have less familiarity with the range of health services available for their children and are generally less satisfied with the English-speaking mainstream services that they have utilised in the past.
There is a need for further examination of these issues with future studies, using more culturally appropriate qualitative methods and larger sample sizes. A better understanding of these issues within Vietnamese Communities in Brisbane and throughout Australia will result in the delivery of more culturally sensitive and effective health services to children and families within these communities.
The author would like to acknowledge the supervision and support of Dr. Alison Harris, the assistance of Dr. Linda Shields in the initial development phase, and the assistance of Dr. Michael O’Callaghan. Her thanks go to Dr. Anne George and Dr. Cherylynn Bassani for reviewing manuscript drafts. She would like to thank Virginia Leyden for her assistance in the focus group discussions, recruitment, and questionnaire completion. Last but not least, she would like to thank the staff at Inala Child Youth and Family Health for their enthusiasm, dedication, and support. This study was supported by Queensland Health, Queen Elizabeth II Hospital Health District (QEII). Ethics approval was obtained through the Princess Alexandra Hospital Ethics Committee.