Cultural Identity as a Determinant of Health among South Sudanese in Sydney, Australia

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Background
Identity, the "totality of one's perception of self" [1], p21, has been widely explored among migrant populations in western countries, particularly in the context of changing perceptions of cultural integration and acculturation following migration.Tere has been less emphasis on cultural identity as a determinant of health, shaping social, cultural, and mental wellbeing [2].Te contextual and dynamic nature of identity has particular resonance for migrant populations who negotiate senses of place and belonging [3].
Factors that infuence cultural identity and congruity during resettlement include a range of complex social, cultural, political, and economic drivers that in turn are intrinsic determinants of health.Tis may vary depending on the life domain of interest according to individual conceptualisation [4].Tey include both enabling moderators such as sense of community, access to care and resources [5], and barriers such as communication issues, restricted access to employment and education, social isolation, and structural racism [2,4].
In addition to these stressors and challenges of migration, there are often cultural schisms between beliefs and practices of their country of origin and their new home country [4], with refugee migrants typically carrying an additional trauma of risks to life and safety that have led to feeing their country of birth [6][7][8][9][10].Ongoing family separations, usually coupled with a restricted ability to return to home countries, further contribute to escalated risks of mental health issues [9,11].
In Australia, the current South Sudanese community mostly arrived as refugees through a humanitarian program in the early 2000s [12], often after living in refugee camps for several years in diferent countries prior to eventual resettlement in Australia.Much of the research on the South Sudanese experience has been conducted in the early years after arrival and mainly focused on resettlement stressors.Some narratives of this community in the popular media and political commentaries have depicted South Sudanese as people who are not integrating into the Australian community, involving an explicit or implicit process of divisive racialization harmful to the sense of identity and belonging in the community [7,[13][14][15].A signifcant portion of the community has now been in Australia for more than ten years and has begun the process of acculturation and integration into Australian society.Tis same period is suffcient for developing a bicultural identity that combines elements of community members' heritage culture with a new identity as part of the Australian population [16].
Literature exploring Australian refugee experiences postmigration is consistent with the overall themes described above [7,17,18], particularly related to mental health stressors [9,19,20].However, much of the research has been conducted shortly after arrival in Australia, and resettlement stressors are likely to have heavily infuenced their narratives of identity as migrants from refugee backgrounds.
Tis study reports on identity as a determinant of health among the South Sudanese community in Sydney, Australia, examining the elements of a dual identity that shape physical, mental, and social wellbeing and resilience and cultural adaptation in the Australian context following migration.Tis understanding is vital to inform policies and services that better support and strengthen a sense of belonging, improved resettlement outcomes, health, and social wellbeing.

Study Design.
Te qualitative study design aimed to understand the lived experiences of identity among adult South Sudanese refugees who had resided in Sydney for 10 years or more after feeing their birth country, migrating to Australia, and rebuilding their lives.
Tis study design was informed and underpinned by a rights-based approach developed by Ager and Strang [21], used to characterise the experiences of study participants.In this schema (Figure 1), key themes were identifed that defned core domains of integration [21].First, Ager and Strang posit that "markers and means" such as employment, housing, education, and health are important for constructing concepts of belonging.Following this is the sense of social connection a person develops in their new community, including building social bridges, social bonds, and social links.Te third stage involves facilitators such as language and cultural knowledge and a sense of safety and stability.Te fourth and last domain is centred around a person's foundation in a new place in the form of the rights they enjoy and their citizenship status.Ager and Strang's framework is well recognised and referenced on studies about identity, belonging, and integration (see for example, [22,23].Our study used the Ager and Strang framework to guide the analysis of our study.

Study
Setting.Tis study was conducted in metropolitan Sydney, the largest city in Australia, with a population of approximately 5.4 million people [24].One in three Sydney residents are born overseas, and about 21% speak a language other than English at home [12], refecting the cultural and linguistic diversity of the city.Since the year 2000, South Sudanese have resettled in Australia under its humanitarian refugee resettlement program, with just over 1,000 NSW residents listing South Sudan as their country of birth [25].

Recruitment and Sampling.
Purposive and snowballing techniques were employed to recruit participants who responded to advertisements through community leaders, community workers, community social media groups, and community-based organisations.Tese stakeholders were provided with explanations about the aim and scope of the study and were asked to invite community members to participate in the study.Interested participants contacted the researchers directly to arrange for an interview.Participants then referred someone they knew in the community to contact the researcher.Potential participants were directly approached by these community leaders and community members, asking them to participate.Participants were included in the study if they (1) Were aged 18 years or older (2) Had lived in Australia for at least 10 years and (3) Were not born in Australia and identifed as of South Sudanese heritage All but one participant (who was not included due to relocation from Sydney) that contacted the researcher participated in the study.

Interviews.
Semistructured interviews were conducted in 2020 and 2021 with twenty-six adult South Sudanese individuals (19 males and 7 females), six face-to-face (before COVID-19 social distancing regulations were introduced), and 20 interviews via telephone.Te interview guide (see Supplementary material 1) was developed by the research team in relation to the research questions.Te research team considered the main research question which in turn guided development of the interview guide questions to tap into the key areas to elicit information from participants.Although questions were designed to elicit particular information from participants, they were kept fexible to allow for the investigation of interesting and similar information on the issue being explored.Also, there were probing questions for further elucidation into the areas of investigation.Te interview guide explored how participants identifed themselves in Australia, what makes them identify themselves the way they did, their experiences of settling in Australia, changes in their experiences over time, social and general life situation in Australia, the perceptions of South Sudanese people in Australia, and how they saw themselves and that of the general South Sudanese community in Australia.
All face-to-face and phone interviews were conducted by WM, an experienced qualitative researcher, and a new member of the South Sudanese community in Sydney.None of interview participants were previously known to WM.According to participants' preferences, all but two interviews were conducted in English, with two participants speaking interchangeably in English and Juba Arabic (a commonly spoken form of Arabic among South Sudanese people).Each of the semistructured interviews lasted between 45 and 90 minutes.Te interviews were digitally recorded with participants' consent and subsequently transcribed (by a member of the community who is a trained and certifed bilingual interpreter) and anonymised.
2.5.Analysis.Data were analysed thematically using an interpretive approach [26] in stages by WM, GV, and TN.First, the researchers familiarised themselves with the data, reading a designated number of transcripts and drafting a coding framework to achieve consistency.Independent coding of the data was then conducted, followed by further discussions to identify similarities and divergences, and a consensus was reached to resolve any diferences between and among the independent analyses.Tird, the codes were consolidated into three themes and interconnected domains that illuminated the experience of identity among the South Sudanese people.Te last stage of the analysis involved interrogating the themes for their relevance and how they ft into the existing literature.Regular meetings were held among coauthors to critique the process and analysis and discuss emerging fndings.NVivo software was used to assist with the coding process of the interview data.

Ethical Approval.
Ethical approval for the study was granted by the Human Research Ethics Committee of the university where the study was carried out (approval number: 22101).All face-to-face participants provided written consent before taking part in the interview.However, when social distancing regulations were introduced in Sydney because of COVID-19, the ethics application was modifed to allow for data collection and verbal consent given over the phone prior to interviewing.Before commencing the interviews, issues relating to confdentiality, data anonymising, and opting out of the study were reviewed with participants.Note-taking was not conducted in order to facilitate a conversational fow that focused on participants and their narratives.

Findings
3.1.Participant Characteristics.Twenty-six participants were involved in the study, including seven females and 19 males.Teir ages ranged from 25 to 64 years, with an average age of 42 years.Although participants had similar experiences of dislocation as refugees, they difered in their trajectories of the migration process, with many forced to leave their country of origin as children to a second (or third) transit country of asylum (Uganda, Kenya, Syria, Egypt, Ethiopia, and Lebanon) before being resettled in Australia.A majority came with family members.Twenty participants had lived in Australia between 10 and 19 years, with an Participants described a multiplicity of interconnected domains that governed the negotiating and making sense of identity.Tis was categorised into three major themes, in turn mediated by other interwoven personal and structural factors and stressors (Figure 2).Te frst theme was around cultural identity as a transitioning process, shifting between ambivalent feelings of optimism, contentment, confusion, and agency according to context and experiences.Te second related to preserving cultural heritage, language, and identities, particularly across generations.Te last theme centred around facilitators and constraints of identity construction including access to education and employment, cut through by challenges of discrimination and racism.Tese themes were examined both through the lens of social determinants of health and Ager and Strang's framework for integration [21].

Mutable Identities, Dependent on Context.
Identity was shaped by a matrix of infuences that inevitably developed over time and was contextually driven.Tis contingent identity and adaptation were woven into participants' stories of arrival, resettlement challenges, family, work, and community.Narratives of building lives in Australia helped explain how they negotiated shifts in cultural identities and how this evolved.Te age at which participants arrived infuenced perspectives, with some of those who had arrived as children commenting that they felt it was easier for them than their parents.

Ambivalence, Contradiction, and Context.
Identity was defned by circumstance and environment, with participants refecting on how this shifted over time and according to the physical location.Most talked to some degree about learning to move across invisible demarcations of identity, according to work, community, and family life.
Tis process was framed beyond rationality: it was grounded in values, spirit, and heart.For some, this was expressed as a shifting identity to the country where they had lived for most, if not all, of their adult lives.Tey described it as "a feeling thing" [P1], refecting on physical appearance and identity, contrasting how they looked and now felt in Australia ("looking like the minority but feeling in the majority") and their birth country of South Sudan ("looking like the majority but feeling in the minority") [P1].
Ambivalence and contradiction were evident: an Australian identity was the "other" for several, with references to "them," "they" rather than "us" and to "ftting in": "What's. . .being an Australian?I think it is just ftting in into their culture."[P6] One described themselves as primarily Australian in identity initially in the interview but then later as being more Sudanese ". ..which probably contradict [s] what I said earlier but this is me" [P23].
Having "two legs" was described and that there were elements of not ftting in wherever they were It's a very confused identity and it is defned by the context you are in.So, if you are in Australia, you pretty much think that you are a South Sudanese, but the way you feel might be diferent.And there is no way to test that unless you leave Australia and go back to South Sudan or Africa.And then you realize that you don't belong there either, so that's how I see myself.

[P1]
For others, their sense of location and belonging was embedded in the land that had raised them: South Sudan was the country in their heart [P11] [P17].Tey felt that life was rich back in their birth country, with a connection to land and community ownership supporting an attachment to spirit and ancestors."We even have our own hunting place . . .So I feel like I'm still attached there with the spirit and everything. . .It is because we feel that we all should have lands, and our ancestor and great, great ancestor and everything, [where] their blood [was] buried" [P17].

Civic Rights and Responsibilities: Citizenship and
Identity.Identity was linked to a sense of contributing to a country: to its economy and society, building the next generation and adopting values; citizenship in the context of civic responsibilities as well as rights.

I'm contributing equally as any other Australian person born in Australia. To the economy, I pay my tax and I'm working. And so, I also have a son here in Australia. So, I see myself as Australian. [P3]
Citizenship straddled two cultures . . ."Regardless of the citizen I become, and regardless of any other thing that I may enjoy here, for example, in Australia, I will not forget my identity, my roots, regardless of anything.Here in Australia, I am part Australian at the same time, because I've got rights to do everything."[P12] Responsibilities to the community were described by most but varied whether this was primarily to Australia or Sudan.For one, their giving back was to their people in South Sudan ". . .who contributed in my life. . .Tat's why I always feel I still belong there" [P11], while others spoke of their (now) primary obligations to Australia.A divergent perspective argued for the imperative to stay in Australia rather than going back to postwar South Sudan: there was an imperative to build a "good community" in their new home for the next generation [P4].
Te mutuality of this responsibility was referred to by some, who stressed that a capacity to contribute and build identity developed over time.Being refugees meant they came to Australia under difcult, sometimes horrifc, circumstances and often without a support base with which to start their life."Tey need support.And they need to be well.To feel that they are welcome in the country" described one, in order to be able to contribute as equally as any other person.[P3] 4 Health & Social Care in the Community Tere were mixed views about their children growing up: wanting their kids to be easy with their own identity in Australia but to also hold close to their culture and heritage.Parents grappled with anchoring kids, and being anchored, within and across their dual identities: cultivating nourishing "glue into oneself" for children [P23] that connected   Participants expressed conficted perspectives, recognising that their own ambivalence was not refected in their children, who were more grounded in an Australian identity.One parent spoke of returning with their children to a postwar South Sudan ". ..if all the best come to the best", taking what had been learnt in Australia to help rebuild the country.Yet, later in the interview, this participant acknowledged that, while they themselves felt more South Sudanese than Australian, they knew their children were diferent.[P17] Parents wanted their children to hold onto a bicultural identity with pride, referring to two cultures, dual citizenship, and two identities."And he should feel head up that he has two cultures.Tat's important.Some people only have one culture.He has. ..African culture.And also the Sudanese cultures.And also the Australian culture.So, that these . . .unite together.And then yeah, that will make him to be who he is".[P3] Culture as a two-way adaptation and learning process was discussed in the context of Australian multiculturalism, ". ..because this is a multicultural country, I also have to make sure that my culture is also implemented where I am here".[P13], as well as questioning how children could hold onto to their traditions: "So how can we make it that we bring up kid in a multicultural society not a South Sudanese traditional way of upbringing?" [P4].
Others described their children interacting with and identifying more with other African young people, gravitating to a pan-African identity in order to form the support amongst themselves, as a consequence of being "lumped into this one homogenous [African]

group and they're victims of discrimination." [P19]
Difering perspectives were introduced by participants who had arrived as children and grown up in Australia, with one refecting that, while he felt comfortable in his identity, he did not see the older generation sharing that. . ."I feel like the older generation who, I guess, brought the kids here, are [here] just basically for the sake of the kids.I don't think they're as happy as us.". . ."And often they're talking about going home when they retire."

., "You don't need to make a phone call to make a family tree because I can still read back fve generation, so you just copy what I'm giving you because I'm still the living biological tree." [P17]
Tis continuity of cultural identity required commitment and not being "quiet:" the frst generation born in Australia needed to know their origins, and in particular, their culture, to pass on lest in time it disappeared ". ..just within maybe two generations, when they start producing their children, those children, they don't know their grand, or great parent came from, because we shall not be there anymore".[P25] Strong community was stressed as being critical to this continuity [P19].Another participant spoke of their community's strength of identity, forged by the legacy of their country's struggle and trauma: So as South Sudanese, we have . . .experience that is defned by struggle: personal struggles and collective struggle. .

. But generally, the way most of us from the South Sudanese community see things, we are very strong when it comes to identity because, in the frst place, that's what brought us here. [P1]
Generally, participants called for stronger cohesion among their community, some refecting on what they saw as a weakening of bonds over time.Tey refected that, along with the growth of the Sudanese community over the last twenty years, came divisions in tribal lines that had not existed on frst arriving.[P12] It was felt more efort was needed to build harmony: "Tere's no need for us to be fghting each other in this land as well".Te challenges of retaining birth language(s) were refected on, particularly in settings where there were multiple languages spoken in family and community [P18].Marriages and partnerships were described where English was the common language spoken, even for South Sudanese parents from diferent tribes [P11, P4, P12].Parents spoke of teaching children Juba Arabic and other South Sudanese languages, but acknowledged this was challenging ". . .so my kids are confused, to be honest."[P11], ". ..but the kids are 100% into English. ..So we're trying to push onto our language for them to learn it, but it's a journey."[P12] Another parent wanted their children to understand their language as part of their background "It's very important because language is the origin of the culture. ..Plus, it is just a tiny bit of us here" [P18], but also other languages "For a kid, they have ability to learn diferent languages.So if they can know my language, plus English, other languages, that's fne".

However, this was viewed in an overall context of identity and belonging which was ultimately up to the children: "So it would be up to [the children] to identify as South Sudanese or as Australia. But my only thing is to make sure that I educate them to be a good citizen of Australia." [P4]
Holding onto their birth language was important for participants themselves, who described using a mix of dialects, Equatorian languages (particularly Juba Arabic) and English according to setting: "So because. . .I'm a Madi, then I see a brother from Madi, then I just feel I need to speak to him in the language."[P12]

Facilitators and Constraints of Identity Construction
Driving Determinants of Health 3.4.1.Support, Services, and Community.While several of the participants spoke of access to (mental and physical health) services in the context of identity, the imperative for traditional community support and networks was usually woven in as a consideration.For some, their experiences helped them "feel Australian." "Yeah, because we got a lot of services from Australian government, like health, education. . ..Tis is really good.Especially the health system is good.So, I also feel not ignored."[P8] However, other participants talked of reluctance to reach out to formal support services, contrasting their experience in Africa and citing a lack of trust: "And mental health, . . . in Africa you go and people help you and you talk to elders, but here you go and tell your issues (to) people, they carry it to someone and it becomes an issue, so you just struggle on yourself.It is so hard in Australia, even now, people are going through a lot in the community with mental health, issues of stress or depression, domestic violence, no one shares because they think it will be taken out and things just go out there, so no one trusts each other, so it's hard."[P26] One participant spoke directly to the need for mental health support, stating that . .."Te mental health is really not properly handled with South Sudanese people.A lot of people are depressed or they are stressed, because they're not ftting in and . . .so . . .people need to have some forums where people can discuss issues like that, and how to deal with it."[P12] Te role of the Church community was referred to as an important support in transitioning through difcult years where acceptance was not always felt ". ..church kind of helped with that, with the whole acceptance.And they directed us to certain schools that might not judge . .." [P7].
Te depression and stress resulting from racism and discrimination [P7] and "trying to ft in" [P12] was also refected on.

Education and Employment.
Participants spoke of the linked centrality of (access to) education and employment with identity and agency.Several participants spoke appreciatively of their access to and support for education and living, including mentoring, and how this instilled confdence and a sense of contribution to community and family ". .

.it feels much better, good, like a human being now I feel like a grown up." [P21] "Education is not for everybody, but it seems to be the best way if you want to be successful. [P7] "Ten you feel like you're now even contributing to the family or even to the community." [P21]
However, frustration was expressed by some, who felt that access to education was not matched by their employment opportunities.Tey spoke of what felt like insurmountable struggles to get their frst job ". . .after you went through all 100 agencies and they said one thing, so you come back and you say to yourself, "What do I do now?",refecting that they survived and did get work, describing the resilience they built in "passing it" [P4].
Another described completing multiple degrees (with attendant student loan fees accumulating) before they were able to fnd themselves in the workplace [P8].Tey were frustrated at not being able to work in their feld of Health & Social Care in the Community specialization with the inevitable loss of skills and knowledge from a degree that not being used.Describing underlying discrimination, this participant advocated for volunteering to prevent protracted unemployment and cut through what they saw as the frst-job barrier [P4].Lobbying a Prime Minister to leverage votes for improved work opportunities was given as an example of a situation where discrimination precluded employment in a regional town, with participants having to travel four hours away for paid work [P11].
Another participant who arrived in Australia as a child described feeling comfortable with both South Sudanese and Australian identities matter-of-factly commented that . .."I always have to push to be better than my white counterparts, because I just know that they'll pick them over me if I'm not better than them."[P5] Tis was commonly referred to, with one describing the fnancial and family stressors in the context of education and work constraints and discrimination [P7].One parent felt that the lack of educational qualifcations in their community had a limiting infuence on their children, who, she felt, had little motivation to attain postsecondary formal education [P18].Acknowledging these challenges, another spoke of their determination in preparing their children for a "second place here in Australia," not taking anything for granted [P12].
Parents and community leaders were called on to counter what they saw as limited education opportunities through community-based tutoring initiatives.Tey urged parents to support their children, strengthening education and career opportunities which they saw as promoting identity construction and confdence . .

3.4.3.
Racism Limiting Identity Reconstruction.Discrimination and racism challenged identity formation.Tis was experienced in many ways, occasionally overtly but often more subtle.It ranged from being told to "go back to your country" as a child, to persistent questioning of "where are you from" to feeling "other," to what was seen as discriminatory media portrayals, to limited work opportunities.
Tere were diferent responses among participants relating to the question "where are you from," with most feeling the question was inappropriate and usually laden with racist overtones.When responding with their neighbourhood home residence, participants were further prodded to identify their country of origin.Some spoke of responding diferently according to who asked the question, while others gave the transit country to which they fed as their country of origin "Because people look down if I say I'm from Sudan.

" [P7]
Even now, how many people ask me, "Where are you from?"And then I say I'm from Penrith.And somehow they think that I'm trying to play some trick . . .And then I realize, "Oh, they want me to say I'm from South Sudan."[P1] Tese are silly questions they ask.Even us we don't ask them.We don't ask these white people where do you come from?[P8] Others described the racism being defected with dignity, particularly by those who had been in Australia for longer periods of time [P1, P12], "Te tone of the asking is not really wanting to know where you come from, but I tell them proudly I come from South Sudan, and I'm an Australian. . . .Ten I question them.. "What about you, where are you from?" [P12] Racism contributed to a lack of belonging and aversion to living in Australia.Citizenship did not stop this sense of being "other" for some: "But basically, I know majority of the white people, they don't consider you as being Australian completely.Tey see you halfway, they see you more, say 75%, if not 100% as from somewhere else, although you have the citizenship."[P17] Others felt simply that they were not welcome ". ..Because when somebody said to you go back to your country, that means this is not your country. .

."." [P3]
Several commented on negative media portrayals of South Sudanese and how this infuenced and reinforced stereotypes.Frustration was expressed that, while coming from "a broken world" [P16], the violence described by media was not realistic.Tese portrayals leaked into "everyway," work, getting jobs, and community relationships: "You have to try and convince them more that you're not what the TV is saying or what your image is being put out to be" [P6].Parallels were drawn with other communities that had experienced similar discriminations and stereotyping: there were lessons learnt, they felt, in looking to how Lebanese communities had addressed antipathy and discrimination in the media.Strong, cohesive leadership from all-African communities speaking with authority and one voice [P23] was called for to shift reporting and stereotypes.
Central in this narrative was the impact on children: the fear of discrimination extending to participants' children, confning aspirations and ambitions for the next generation.Citing experiences of racism, parents expressed concerns about their Australian-born children being rejected from, and in turn rejecting, their Australian identity.Countering discrimination was thus seen as critical in order to support generations to come ". ..to turn that page.Because if we don't do it today, our children indeed [will] be seen the way they also see us today" [P12].
While for most participants, a gradual process of adapting identity was described, for one, it was more dramatically related to a visit back to South Sudan, which triggered a shift in nation-identity perception as well as confdence in countering racism:

Discussion
While much has been written on early experiences of South Sudanese in the context of trauma and hardships feeing a war-torn country, there is little exploring the journeys and identity construction for South Sudanese refugees who are long-term residents and citizens in Australia.As a relatively small demographic, this population is disproportionately afected by disparities in the major social determinants of health.Challenges in identity reconstruction and strategies in acculturation and identity adaptation were described by participants in our study, who often expressed ambivalence as they navigated core domains of integration as defned by Ager and Strang [21].
Underpinning markers and means, employment, housing, education, health, was variously described in supporting as a sense of belonging.Mental health stressors related to isolation and depression were referred to, particularly in the context of cultural and structural barriers to support services (both seeking and access).Our fndings agree with other studies, which report mental health stigma (particularly amongst women) inhibiting seeking out support [27][28][29], with stigma and shame reported by both African migrants and service providers as a determinant of poor access [28].While stigma associated with mental health challenges is not unusual, it carries added weight in South Sudanese refugee populations who have often experienced signifcant trauma premigration [30].Refections on social connection, language and cultural facilitators, citizen rights, status, and responsibilities varied.Temporal shifts were noted, with many participants describing changes over time in how they experienced key domains of identity and integration.As refugees, South Sudanese have usually come to Australia after extended periods in refugee camps, often under challenging situations [17].Participants recognised the importance of time needed to establish themselves, build and rebuild their identities, and make what they saw as notable contributions to Australia.
Education, employment, and belonging are important determinants of health [31,32] and critical underpinnings of integration in a new society [21].Access to formal education opportunities in Australia was described with appreciation, instilling a sense of empowerment and hope.However, these opportunities were generally not matched in the work setting: structural barriers constrained employment options, particularly in participants' early attempts.Although most participants were engaged in work, a lack of employment opportunities and underemployment were both described, which negatively afected their health and integration.Selfreliance and employment are vital underpinning determinants of dignity, social capital, and identity formation.Te barriers described in this study are consistent with other refugee experiences [17,[33][34][35] and shape their ability to participate in health-promoting activities [36].Employment barriers were exacerbated considering the youth of South Sudanese, with most arriving in Australia under 25 years of age.Our fndings on the relationships between identity formation in relation to work for refugees in diferent countries are not unusual [37][38][39][40].Wehrle et al. describe how multiple integration barriers in relation to work and society can also threaten refugees' fundamental identity needs for worth, distinctiveness, continuity, and control [41].Tese complex matrices of identity infuences as they relate to work agree with our fndings, along with the call for stronger support mechanisms to facilitate employment opportunities and reduce postmigration stress, particularly in the early years of arriving [42].
Many participants in this study felt they were both Australian and South Sudanese.Australian identity was perceived through contribution to the economy, attaining education, buying houses, and starting families.Tese are important determinants that facilitate health and wellbeing as well as integration into society [21].Obtaining Australian citizenship was an important driver that informed identity, conferring civic rights and evoking a strong sense of obligation to contribute to the economy, community, and country, consistent with other research [43].
Most participants had formed or were in the process of forming their own family, a situation where bicultural identity tends to be signifcant.A striking theme was the consideration of how culture and identity would be passed on (and shift) for their children, with most participants describing the importance of instilling a South Sudanese identity associated with empowerment and confdence.Some referred to the need to take children back to South Sudan to connect with their roots and identity.Yet the country's protracted confict conficted with this desire.Citing experiences of racism, others expressed concerns about their Australian-born children being rejected from, and in turn rejecting, their Australian identity.Underpinning the narratives was the need (and right) for children to have a place to call home.
Social connections within the community were viewed as an important support base that could be leveraged to promote integration and realize contribution to Australia, facilitating cohesion and promoting health for individuals and community.However, achieving integration and a full sense of belonging was eroded by how this community is perceived in Australia.Experiences of racism, discrimination (direct and indirect), and a sense of "otherness" generated a questioning of identity and belonging.Te well-recognised destructive health impacts of racism and discrimination [44][45][46][47] were layered on the legacy of refugee experiences in our study.
Te diverse contexts in which participants in this study described identity highlight its dynamic nature, which evolves and reshapes to refect individual situations in time, place, and context.Resources and structures needed for integration identifed in this study mirror those defned by Ager and Strang [21] and shape the concept of identity.Based on the narratives in this study, building identity is a two-way interplay involving the receiving community and the South Sudanese community in Australia.Terefore, it is important to consider the impacts of the receiving community on identity construction, particularly in providing environments, structures, and resources to better support integration and acculturalisation.It is critically important to Health & Social Care in the Community consider the complexities, nuances, and determinants of identity construction among the South Sudanese nity in Australia when working with their community.
Te dimensions of this study's conceptual framework of identity and related determinants of health align well to that of Ager and Strang.Te complex factors arising in our study that infuence identity, particularly those related to mental health, integrate with and provide a context for the structured core domains of integration that Ager and Strang outline.

Strengths and Limitations.
Most studies of refugee experience in resettlement focus on trauma and migration.Our study examined the lived experiences for South Sudanese migrants over time, highlighting the evolving and often conficting factors that shaped domains of integration and identity construction as determinants of health and social wellbeing.
While most participants referred to employment, there was a lack of specifc reference to occupation type by most.Interview questions did not directly address health; however, aspects of mental health were expressed in relation to resettlement, integration and identity.
It was assumed that there may be challenges in recruiting participants from this community related to trust; however, this may have been mitigated by the recruitment process (which involved contacting community leaders and other key stakeholders frst) and the fact that the interviewer was South Sudanese, which may have supported a sense of safety.Using community-based recruitment strategies rather than service providers gave a breadth to participant involvement, who included both those who do and do not normally use services.Te impact of COVID necessitated the conducting of interviews via phone for all but six participants, with its associated potential challenges and benefts [48].

Conclusion
Tis exploration of lived experiences among South Sudanese refugees in Sydney, Australia, found that identity construction was impacted by an array of interconnected health and structural determinants that governed the negotiating and making sense of identity.In turn, these determinants shape physical, mental, and social wellbeing and resilience and cultural adaptation.Tese factors provide a hitherto unavailable understanding of how South Sudanese see themselves and understand their identity over time in the context of migration to Australia.Tis understanding is vital to inform policies and services that better support and strengthen sense of belonging, improved resettlement outcomes, health, and social wellbeing.Te deeper, more nuanced understandings of bicultural identity within a strength-based framework call for enhanced investment, better partnerships, and services to support capacity, particularly in workforce settings, and participation in Australian life to the greatest extent by South Sudanese and other refugees.

3. 3 .
Preserving Culture: African Heritage, Language, and Intergenerational Factors.A strong theme threaded through most participants' narratives was the consideration of identity in relation to their children.Tose who articulated a sense of belonging and identity expressed hope, pride, and achievement, particularly in relation to their children.[P4][P18][P21][P24]: "I think that there's a great hope, generally, yeah, it is a great hope, especially for kids" [P21].Tey diferentiated their own identity from that of their children at several levels: ". ..so basically, I'm more of actually South Sudan than Australia, but my children would be diferent."[P17]

[P5] 3 . 3 . 1 .
Preserving Culture-across the Generations.Strategies to maintain continuity of cultural identity and structure across generations included both formal (youth rallies, language classes) and informal (community social gatherings) initiatives.Instilling knowledge and pride for children about cultural heritage was imperative to building cohesive communities and ". ..to know exactly the root of the parents. . .And they're going to explain also to those [next] generation. .." [P25].Another spoke of passing on their oral history and lineage to children:[My children] try to make their own family tree.And I said. .

Table 1 :
Participant characteristics.back to Africa and South Sudan.Tey feared not being around to their children from racism, referring to their own resilience forged from past experiences and doubting if their children would feel as anchored ". ..because when I'm not here and they are told that they are not Australian, I don't know how they will feel because they have not been formed by what formed me." [P1] Temes related to identity were discussed in the context of children and traditional family roles.Men described being challenged to step out of their own traditions and changing divisions of labour within the family [P4][P9][P13][P17].Tere were concerns expressed about changing roles in relation to daughters [P4][P21].For . ..a girl when they move out of the house, that is the time you're getting married . ..But here now, somebody gets into 20 or 22, they want to move out of the house.It's like such a shock for us parents . ..maybe they went out because of the education, or maybe they'll go out because for the nature of the job they're doing.But sometimes we as parents we look at it like it's not a good thing. . ..Yeah, these are some of the things that mean ...parents to be educated how life is here diferent...How are we to prepare them at that stage? .... So it's very challenging for us parents.[P21] them Self-reliance and direction were also described . .."InAustralia, life you're the one who make it easy, you're the one who make it difcult in Australia."[P14]