Acculturation and health outcomes among vietnamese immigrant women in taiwan

Acculturation and Health Outcomes Among Vietnamese Immigrant Women In Taiwan Yung Mei Yang Queensland University of Technology School of Nursing I II Queensland University of Technology School of Nursing Faculty of Health Institute of Health and Biomedical Innovation Acculturation and Health Outcomes Among Vietnamese Immigrant Women In Taiwan Yung-Mei Yang RN, BA, MS This thesis is submitted to fulfil the requirements for Degree of Doctor of Philosophy at the Queensland University of Technology 2008 III Statement of Original Authorship “The work contain in this thesis has not been previously submitted to meet requirements for an award at this or any other higher education institution To the best of my knowledge and belief, the thesis contains no material previously published or written by another person except where due reference is made.” Signature:……………………………………… Date:…………………………………………… IV Scholarships/ Awards Research Scholarship, Grand-in Aid Scholarship for international conference(2007) Queensland University of Technology, Australia Research Project Funding, National Science Council of Taiwan (2007-2009) Participatory action research of acculturation and health promotion strategies among SEA new immigrant women in Taiwan Research Scholarship, Write up Publications Scholarship (QWU)(2008) Queensland University of Technology, Australia Nominate “Outstanding Thesis Award” (2008) Queensland University of Technology, Australia Publications for preparation (2008) Yang, Y.M Anderson, D., Wang, H.H., & Barr, J (2008) Globalized vs.Marginalized Women: The relationships between acculturation, socio-demographic factors, and health-related quality of life among Vietnamese migrant brides in Taiwan Journal of Nursing Scholarship (SSCI,Impact Factor: 1.25 Journal citation reports 2007) Yang, Y.M Anderson, D., Wang, H.H., & Barr, J (2008) Predicting psychological distress among Vietnamese marriage migrant women in Taiwan: A classification and regression trees (CART) model International Journal of Nursing Studies (SSCI,Impact Factor - 1.07 Journal citation reports 2007) Yang, Y.M Anderson, D., Wang, H.H., & Dulp, R (2008) Marriage Immigration: A cross-cultural comparison of health related quality of life among Vietnamese female immigrants and Taiwanese women Quality of Life Research, SSCI (SSCI,Impact Factor: 2.0 Journal citation reports 2007) V Key Words Acculturation Immigrant women Foreign brides Women’s health Short form 36 (SF-36) Health Related Quality of Life (HRQOL) The Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA) The Demand of Immigration Specific Distress Scale (DIS) Classification and Regression Trees (CART) VI ACKNOWLEDGMENTS My life experiences during these years in Australia are meaningful and unforgettable I would like to thank my supervisory team, Professor, Debra Anderson, Dr.Jenniffer Barr, and Professor Hsiu-Hung Wang who formed the foundation for which I dedicate my dissertation Professor Debra Anderson has been unfailingly patient, supportive, encouraging, and endlessly generous with her knowledge and expertise in research Her commitment to high standards inspired me to put forth my best efforts, and her gifts as a teacher ensured that every step of the process was a valuable learning experience Dr.Jenniffer Barr whose unique focus gave me the direction and encouragement to successfully complete this endeavor Her expertise in women’s health was valuable to my research Professor Hsiu-Hung Wang was my external associate supervisor who has been a mentor and a positive role model in my professional pursuits since I began studying a master degree in Kaohsiung Medical University She generously provided the research resources in Taiwan to further help my project I wish to express my deep gratitude to Professor whose generosity in providing the scholarship helped me to counter the economic difficulties and encouraged me to complete my PhD study VIII This dissertation research could not have been completed without the contributions of many people I would like to thank my brilliant PhD colleagues for their intellectual inspiration and thoughtful suggestions on the research subjects from a cultural perspective; John Robertson correcting and directing my writing I would like to thank Dr Ray Dulp for sharing his knowledge and experience with statistical analysis I sincerely extend my appreciation to research participants for their enthusiastic assistance and coordination throughout the data collection process without their assistance; this study could not have been completed on time I wish to express my deep gratitude to my partner Peng Guan who has walked this journey with me His love and compassion sustained me when I felt low and frustrated because of the demands of my study I could not have reached this goal nor endured the process without love and support of my families Thank you all for your patience and encouragement when I most needed it Especially my parents who took care my cherished children, Kevin, Esther, and Moses with enduring love and compassion while I studied in Australia and supported my academic dream coming true in my mid-life This study was supported by the following grants: a QUT PhD student support grant; a QUT publication write-up grant; and grants from the National Science Council of Taiwan (NSC 96 -26 28-B-037-041-MY2) The author appreciates the help from the grants IX Acculturation and Health Outcomes Among Vietnamese Immigrant Women In Taiwan Abstract Background Recently, Taiwan has been faced with the migration of numbers of women from Southeast Asian (SEA) countries It was estimated that the aggregate number of SEA wives in Taiwan was more than 131,000 in 2007 (Ministry of Foreign Affairs, 2006).These women are often colloquially called, “foreign brides” or “alien brides”; most of them are seen as commodities of the marriage trade, whose marriages are arranged by marriage brokers Some women can be regarded as being sold for profit by their families These young Vietnamese immigrant women come to Taiwan alone, often with a single suitcase, and are culturally and geographically distinct from Taiwanese peoples; the changes in culture, interpersonal relationships, personal roles, language, value systems and attitudes exert many negative impacts on their health, so greater levels of acculturation stress can be expected This particular group of immigrant women are highly susceptible and vulnerable to health problems, due to language barriers, cultural conflicts, social and interpersonal isolation, and lack of support systems The aims of this study were to examine the relationships between acculturation and immigrantspecific distress and health outcomes among Vietnamese transnational married women in Taiwan This study focuses on Vietnamese intermarriage immigrants, the largest immigrant group in the period from1994 through to 2007 X Methodology The quantitative study was divided into two phases: the first was a pilot study and the second the main study This study was conducted in a communitybased health centre in the south of Taiwan, targeting Taiwanese households with Vietnamese wives, including the Tanam, Kaohsiung, and Pentong areas This involved convenience sampling with participants drawn from registration records at the Public Health Centre of Kaohsiung and used the snowball technique to recruit 213 participants The instruments included the following measures: (1) Socio-demographic information (2) Acculturation Scale (3) Acculturative Distress Scale, and (4) HRQOL Questions related to immigrant women’s acculturation level and health status were modified Quantitative data was coded and entered into the SPSS and SAS program for statistical analysis The data analysis process involved descriptive, bivariate, multivariate multiple regression, and classification and regression trees (CART) Results Six hypotheses of this study were validated Demographic data was presented and it revealed that there are statically significant differences between levels of acculturation and years of residency in Taiwan, number of children, marital status, education, religion of spouse, employment status of spouse and Chinese ethnic background by Pearson correlation and Kendall’s Tau-b or Spearman test The correlations of daily activity, language usage, social interaction, ethnic identity, and total of acculturation score with DI tend to be negatively significant In addition, the result of the one-way ANOVA supported the hypothesis that the different types of acculturation had a differential effect on immigrant distress The marginalized group showed a greater immigrant distresses in comparison with the integrated group Furthermore, the comparison t-test revealed that the Vietnamese immigrant women showed a lower score than Taiwanese women in HRQOL The result XI 23.年年 年 年 年 年 年年 年年年年年年 年 Part 4: 年 24 年 年 年 25 年 年 年 26 年 年 年 27 年 年 年 年 28 年 - 217 - 年 29 年 年 3年 年年 年 年 年 年 30 年 3年 年年 年 31 年 年年 2年 年 年 年 年年年 年年 年 32 年 年年 2年 年 年 年 年年年 年年 33 年 年 年 年 年 Part 5: 年 年 年 年 年 年 年年 年 年 年 年 年 年 年 年 年 34 35 36 37 - 218 - 38 年 39 年年 40 5 : 年 年 年 2 3 3 3 3 3 3 年 年 年 年 年 年 年 10 11 年 年 年 12 - 219 - 年 13 14 3 3 3 3 3 年 年 15 年 16 年 17 18 年 年 19 年 20 21 年 年 22 年 23 年 - 220 - Appendix 9: Questionnaire (Backward Translation) Part 2: Choose the one answer which best suitable for you Domain1: daily activity What is your musical preference? Only my home country music Mostly home country music Equally my home country and Taiwanese music Mostly Taiwanese music Taiwanese only What is your TV preference? Only my home country TV Mostly my home country Equally my home country and Taiwanese TV Mostly Taiwanese TV Only Taiwanese TV What is your food preference at home? Only Vietnamese food Mostly Vietnamese food, some Chinese About equally Vietnamese and Chinese Mostly Chinese food Only Chinese food What is your food preference in restaurants? Exclusively Vietnamese food Mostly Vietnamese food, some Chinese About equally Vietnamese and Chinese Mostly Chinese food Only Chinese food Circle your satisfaction in Taiwanese or Chinese food very dissatisfied 2.dissatisfied 3.moderate satisfied Domain 2: social relationships What is your friends‘ ethnic origin? Exclusively Vietnamese Mostly Vietnamese About equally Vietnamese groups and Taiwanese groups Mostly Taiwanese Only Taiwanese With whom you now associate in the neiberhood? Only Vietnamese Mostly Vietnamese About equally Vietnamese groups and Taiwanese groups Mostly Taiwanese Only Taiwanese - 221 - strongly satisfied From whom you receive emotional support? None Mostly Vietnamese About equally Vietnamese groups and Taiwanese groups Mostly Taiwanese Only Taiwanese From whom you get advice and help for specific problems you need? Nobody Mostly Vietnamese About equally Vietnamese groups and Taiwanese groups Mostly Taiwanese Only Taiwanese 10 With whom you socialize and go shopping with? Nobody Mostly Vietnamese About equally Vietnamese groups and Taiwanese groups Mostly Taiwanese Only Taiwanese 11 If you could choose, who would you prefer to associate with in the community? Almost exclusively Vietnamese Mostly Vietnamese About equally Vietnamese groups and Taiwanese groups Mostly Taiwanese Only Taiwanese 12 Please rate the support of your Vietnamese friends? none a little moderate a lot highly 13 Please rate the support of your Taiwanese Friends? none a little moderate a lot highly 14 Please rate the support of your spouse? none a little moderate highly a lot 15 What contact you have with your Vietnamese families? Travel at least once a year Travel less than once a year to Vietnam Occasional visits to Vietnam Occasional communications (letters, phone calls, etc.) with people in Vietnam No exposure or communications with people in Vietnamese Domain 3: language 16 What language you speak in the house? Only Vietnamese Mostly Vietnamese, some Mandarin Equally well (bilingual) Vietnamese and Mandarin Mostly Mandarin, some Vietnamese Only Mandarin - 222 - 17 Can you read? Only Vietnamese Vietnamese better than Chinese Both Vietnamese and Chinese equally well Chinese better than Vietnamese Only Chinese 18 Can you write? Only Vietnamese Vietnamese better than Chinese Both Vietnamese and Chinese equally well Chinese better than Vietnamese Only Chinese 19 What language you prefer to speak at the house ? Only Vietnamese Vietnamese better than Chinese Both Vietnamese and Chinese equally well Chinese better than Vietnamese Only Chinese 20 Please rate your speaking confidence in Mandarin or Taiwanese dialect 1.unconfident 2.a little confident moderately confident 4.confident 5.strongly 21 Please rate your listening confidence in Mandarin or Taiwanese dialect 1.unconfident 2.a little confident moderately confident 4.confident 5.strongly 22 Please rate your reading confidence in Chinese 1.unconfident 2.a little confident moderately confident 4.confident 5.strongly 23 Please rate your writing confidence in Chinese 1.unconfident 2.a little confident moderately confident 4.confident 5.strongly Domain: cultural identity 24 How you think of yourself? I am Vietnamese I am mostly Vietnamese I am Asian -Chinese or Taiwanese I am Vietnamese -Chinese I am Chinese/ Taiwanese 25 What kind of values and beliefs, will you teach your children? Only Vietnamese Most Vietnamese and a little Taiwanese Equal Vietnamese and Taiwanese Most Taiwanese and a little Vietnamese Only Taiwanese 26 If you belong to a Vietnamese group, how much pride you have? Extremely proud Moderately proud Little proud Have no feelings of pride Have negative feelings - 223 - 27 How would you rate yourself? Very Vietnamese Mostly Vietnamese, a little Chinese Bicultural Mostly Chinese Very Chinese 28 Do you participate in Vietnamese occasions, holidays, traditions, etc.? Nearly always Most always Sometimes Occasionally Not at all 29 Measure yourself on how much you believe in Vietnamese values (e.g., about marriage, families, education, work): not believe a little bit moderate 4.very much strongly believe 30 Rate your self on how much you believe in Chinese values: not believe a little bit moderate very much strongly believe 31 Rate yourself on how well you fit when with other Vietnamese friends not fit in a little bit moderate very much fit in very well 32 Rate yourself on how well you fit when with other Chinese friends not fit in a little bit moderate very much fit in very well 33 Which one of the following most closely describes how you view yourself? Even though I live and married in Taiwan, I still view myself basically as a Vietnamese person I think myself basically as a Chinese person Even though I have a Vietnamese background and characteristics, I still view myself as Chinese I think myself as a Vietnamese -Chinese, although deep down I always know I am a Vietnamese person I think myself as a Vietnamese -Chinese, although deep down, I view myself as a Chinese person first I think myself as a Vietnamese-Chinese, I have both Vietnamese and Chinese characteristics, and I view myself as a blend of both Domain 5: perceived discrimination None 34 Because I am Vietnamese, I have to work very hard 35 People show less respect because I am Vietnamese 36 Ethnic jokes or interferences are placed on me which happened at home or at the workplace 37 Because I am Vietnamese, I am assigned a job that no one else wanted to 38 I am treated with less respect and disregard than I should be 5 39 I have been denied hospitalization or medical care facilities 40 Medical providers ignore me and service local people first - 224 - Moderate Very much Most of the time A little Part 3: Your immigrant experience Demands of Immigration Scale (DIS) (Back Translation) Directions: This questionnaire contains 23 items about your personal immigrant experience in Taiwan Please respond to each item as accurately as possible which will indicate the experience most suited to you (recent three months.) 0= no and never 1= a little 2= more than a little 3= most of the time 10 11 12 13 14 15 16 17 18 19 20 21 22 Taiwanese have difficulty in understanding my accent When I remember the past in home country, I feel affected and become emotional Even when I live in Taiwan, it does not feel like my home country I need suggestions from other people who are more experienced than me, to show me how to live here It is difficult to find a good job in Taiwan My work status is lower than it used to be Being an immigrant, I feel I am a second class citizen in Taiwan Because of the language barrier, I feel difficulty in doing common tasks Taiwanese don’t think I really belong in their country I miss the people in Vietnam I have a little chance in developing my career in Taiwan Talking in Mandarin or Taiwanese takes a lot of effort Taiwanese people treat me as an outsider I need to learn new things, such as obtaining a motorbike license I feel that here is not my real home I need to rely on some friends to teach me or show me how things are done here I not feel at home I feel sorrow when I think of special places back home I can not compete with Taiwanese for work in my workplace People with SEA accents will treat me with less respect in Taiwan Taiwanese employers don’t accept my Vietnamese education and previous work experience in Vietnam I am always facing new situations and conditions - 225 - 0 1 2 3 3 0 1 2 3 3 0 0 0 1 1 1 2 2 2 3 3 3 0 1 2 3 0 0 1 1 2 2 3 3 3 23 When I think of Vietnam my homeland, I cry Part 4: Your Health The purpose of this questionnaire is to view the extent your health This information recorded how you feel about your health and your ability to deal with your daily activities Thank you very much for your answering the questions Please circle the number which suits you most In general, How about your health 1= Excellent 2=Very good 3=Good 4=Fair 5=Poor Compare to one year ago, how you feel about your health now? 1= 2= 3= 4= 5= better a little better still the same a little bit worse very poor Below we are asking about your daily activities According to your health, how will this limit your ability to perform tasks, if so, how much? 1=always 2=most of the time 3=sometimes 4= a little of the time 5= no, not at all a Hard working, such as running fast, lifting very heavy stuff, harsh sport b Moderate activities, such as moving a desk, playing bowls or Tai-Chi c Carrying groceries d Climbing several floors of stairs e Climbing one floor of stairs f Bending, kneeling, stooping g Walking more than one kilo meter h Walk several hundred meters i Walking one hundred meters j Take bath or clothe myself During the past four weeks, how often has your health influenced your work or daily activities? 1=always 2=most of the time 3=sometimes 4= little of the time 5= no, not at all a Cut down on the amount of time you spent on work or other activities b Completed less than you thought c Were limited in the type of work or activities d Had difficulty to the job or activities, such as needing more effort to complete it - 226 - During the past four weeks, how often has emotional problems (such as anxiety or depression) influenced your work or other activities 1=always 2=most of the time 3=sometimes 5= no, not at all 4= little of the time a Cut down on the amount of time you spent on work or other activities b Completed less than you thought c Do work or activities less than usual During the past four weeks, how often has your health or emotional problems influenced your relationship with your family, neighbours, or friends? 1= not at all 2=a little bit 3=moderately 4=very much 5=extremely During the past four weeks, how much body pain have you felt? 1= no body pain 2= slightly pain bit of pain 6=very painful 3= a little bit 4=moderate pain 5=quite a During the past four weeks, how much body pain disturbs your daily activities or work? 1=not at all much 2= a little bit 3= moderately 4= quite a bit of pain 5= very The following questionnaire is about how your feelings and experiences during the past four weeks 1= All of the time 5=Never 2= Most of the time 3= Sometimes 4= A little bit a I feel full of life b I am a very nervous person c I feel very upset, nothing can make me happy d I feel calm e I feel I have a lot of energy f I feel unhappy and depressed g I feel exhausted h I am a happy person i I always feel tried 10 During the past four weeks, how much time has your physical or emotional problems influenced your social activities (such as visiting friends)? 1=All of the time 5= No, not at all 2=Most of the time - 227 - 3=Sometimes 4= a little of the time 11 Does one of the following statements below describe you accurately, if so, you think it is correct or not? 1= completely correct 2= mostly correct 3= don’t know 4= partially incorrect 5=completely incorrect a I seem to get sick more frequently than the others b Compared to the other people, my health is as good as them c I think my health will become worse and worse d I have good health - 228 - Appendix 10: Timeline for completion of PhD Program-Yung-Mei Yang 2005 Schedule of Activities FebApr MayJul AugOct 2006 NovJan FebApr Enrollment Stage proposal Progress reports Course work Ethics approval: QUT Stage Seminar Submit Confirmation document Confirmation seminar Conduct research: Phase study Phase study Write-up of thesis Title & Abstract Literature Review Methodology Data analysis Results Discussion Conclusion Outputs Publication (1)(2)(3)International Conference Editing draft of thesis Submit thesis to panel Final seminar External examination - 299 - MayJul AugOct 2008 2007 NovJan FebApr MayJul AugOct NovDec JanFeb MarApr Graduation Ceremony Citation Yung Mei Yang RN,BS,MS Thesis title: Acculturation and Health Outcomes among Vietnamese immigrant women in Taiwan Supervisors Dr Debra Anderson, (Principle) Dr Jennieffer Barr, (Associate) Dr Hsiu-Hung Wang, Taiwan ROC (External) Citation: This thesis is a cross-sectional investigation of acculturation stress and health related quality of life among Vietnamese marriage migrant women in Taiwan This dissertation reflects an excellent report on a very significant new phenomenon that is driven by globalization These young immigrants are highly susceptible and vulnerable to health problems The study revealed that the Vietnamese migrant women showed a lower score than Taiwanese women in health related quality of life, and had higher acculturation stress impact on vitality, social functioning, and mental health In addition, the psychological distress included: alienation, occupation adjustment, loss of social support, language accommodation, and novelty among Vietnamese immigrant women in Taiwan - 300 - - 301 - ... Queensland University of Technology School of Nursing Faculty of Health Institute of Health and Biomedical Innovation Acculturation and Health Outcomes Among Vietnamese Immigrant Women In Taiwan. .. immigrant women in Taiwan? Is there a difference in Health- Related Quality of Life between Taiwanese women and Vietnamese immigrant women in Taiwan? What acculturation factors influence the Health- Related... physical and psychological health of immigrant women Research in Taiwan designed to investigate acculturation and health outcomes among these women is still very limited In order to improve the health