Hepatitis B knowledge, testing, and vaccination among Chinese and Vietnamese adults in Australia

Hepatitis B is a significant public health challenge within some subpopulations in Australia, including Chinese and Vietnamese migrants. There has been limited research on hepatitis B knowledge and actions in these communities. The authors conducted a self-administered survey among 442 Chinese and 433 Vietnamese in Brisbane. Generally, the knowledge is best described as “moderate.” One in 2 could not identify the sexual transmission risk and less than one third knew that sharing foods or drinks did not spread the disease. The majority of Vietnamese (80%) and 60% of Chinese respondents indicated prior testing. Vaccination was reported in 60% of the Vietnamese and in 52% of the Chinese. Knowledge was better among Chinese people who had been tested and vaccinated compared with those who were nontested and nonvaccinated. Only 3.5% of the Chinese, but 11.6% of the Vietnamese, indicated having a positive test result hepatitis B virus. This study helps identify strategies for programs targeting both communities and practitioners.

Estranged bodies and Vietnamese identities

In this paper I will explore both the regulation of migrant bodies as well as the lived experience of migrant embodiment in order to develop an analysis of the body as a vortex of meaning in the displacement process. By examining the way in which the bodies of Vietnamese immigrants are simultaneously object and agent, I will indicate how the relations between migrants and the wider society are felt and sensed through the bodily experiences of Vietnamese people. The dynamic between how Vietnamese bodies are represented and how they are experienced reveals the body to be a predominant marker of difference from both within and without, the mediator between experience and signification. I will indicate how the dominant media construction of Vietnamese bodies as defiled has sustained forms of exclusion and distancing which have influenced the way that Vietnamese bodies are lived. I thus explore the means through which the body has particular salience when attempting to understand the nature of migrant identities in Australia.

Dreams in the Shadows : Vietnamese-Australian Lives in Transition

Explores the experiences of Vietnamese immigrants in Australia. Description What is it like to be a refugee in a country that has a completely different culture from your own, where you feel very different from those around you? With a fine eye for detail and keen empathy for her interviewees, Mandy Thomas explores the experiences of Vietnamese living in Australia. She examines displacement and loss, the ongoing effects of war trauma, and international and community politics. While reflecting on many of the contemporary debates on identity and communality, she explores the concrete realities of Vietnamese lives through their daily experiences. She discusses how Vietnamese families have adapted Western domestic architecture to create a more comfortable home environment, how traditional festivals now serve new purposes, and the changing nature of status and gender relations. She describes the reception of the Vietnamese by the wider Australian society and in the media, and she explores the ongoing ties that overseas Vietnamese have with their homeland. Dreams in the Shadows is a valuable resource for anyone working with immigrant communities, for readers interested in Vietnamese immigration to Western countries, and for researchers of migration and multiculturalism. 'Dreams in the Shadows is a wonderfully sensitive account of Vietnamese in Australia that provides insight into the worlds of Vietnamese immigrants and the often marginalizing orders of the host society.' Bruce Kapferer, Professor of Anthropology, James Cook University and University College London 'A perceptive, sensitive and culturally nuanced account of one of the most recently formed diasporas - that of Vietnamese in Sydney. Deserves to be widely read.' Pnina Werbner, Reader in Social Anthropology, Keele University

Stitching at the boundaries : Vietnamese garment industry workers in transnational spaces

This paper explores the interfaces between the transnational politics of labour and the experiences of Vietnamese women garment workers both in Vietnam and as migrants to other countries. As the global industries have come to organise much of the contemporary economic system, so too have they crossed national boundaries in search of cheap labour. At the same time enclaves of migrant disadvantage within the multi-ethnic nation-states of the developed world have also provided workers for the manufacture of clothing. In the case of Australia, these workers are mostly home-based and not in factories. In this paper I explore Vietnamese women's different incorporations into the garment industry in various locations – in Australia, in Vietnam, and in American Samoa. In so doing, I provide an analysis of the links between gender, global power relations and the contradictory space of transnational exchange.

Socio-cultural dimensions of Active Futures : Importance of studying migrants’ perspectives of wellness

In this paper we provide a migrant perspective on how women and men from a different culture perceive wellness while settling down in a new country. We are discussing the texts of research interviews with Indian migrant women and men that illuminate their perception of lifestyle enhancement in their adopted country Australia. Our purpose is to show how socio-cultural factors influence the migrants‟ perspective of lifestyle enhancement, and to what extent they direct their wellness. Personal development, both in theory and practice, is a huge concept in Australia. Concerted efforts are made towards increasing public awareness about health literacy leading to a better understanding and practice of wellness. However, as research studies have pointed out, lifestyle enhancement leading to holistic wellness is not void of socio-cultural factors. The number of women and men migrating to Australia from India has increased greatly in the present decade. As migrants their participation in developing Australian society is significant. So what is their socio-cultural perception of wellness including nutrition and physical exercises as active citizens? How do young Indian migrants participate in lifestyle enhancement programmes? As parents what are their socio-cultural beliefs, attitudes, practices and values, and how do they influence their children‟s participation in personal development and PE progammes? To what extent gender differences exist in such participation levels? What is the space available in State school curriculum to learn from the migrants‟ cultures towards enhancing lifestyles including nutrition and personal development?The findings may sensitise Australian researchers, academics, school teachers and practitioners of wellness therapies. Long term research studies may inform the governments and HPE practitioners of the changes occurring in such values, beliefs and practices as they incorporate nutrition and lifestyles of Australian society.

Perceptions of acculturation and social identity construction among three Taiwanese/Chinese migrants in Australia

In recent years, increasing numbers of Chinese migrants have come to Australia to study or to live. In doing so, they have entered a new cultural space. They are faced with many challenges, not only to do with study experience, workplace experience and life-style practices, but also to do with language, communication, culture and identity. Such new challenges can feel dangerous, unstable and uncomfortable as they require moves out of the safety zone of primary cultural experience. This qualitative research study investigates the perceptions and narratives of three Taiwanese-Australian migrants in terms of their experience of this process of acculturation and social identity construction as migrant tertiary students in the new Australian context and of their subsequent experience professionally. Their accounts of where they see themselves to have 'landed' in terms of their acculturation process and identity construction might provide relevant insights to the experience of hybridity which is intercultural Australia.

Immigration distress and associated factors among Vietnamese momen in transnational marriages in Taiwan

The purpose of this study was to explore the types and predictors of immigration distress among Vietnamese women in transnational marriages in Taiwan. A cross-sectional survey with face-toface interviews was conducted for data collection. A convenient sample of 203 Vietnamese women in transnational marriages in southern Taiwan was recruited. The Demographic Inventory measured the participants’ age, education, employment status, religion, length of residency and number of children, as well as their spouse’s age, education, employment status and religion. The Demand of Immigration Specific Distress scale measured the level of distress and had six subscales: loss, novelty, occupational adjustment, language accommodation, discrimination and alienation. Among the 203 participants, 6.4% had a high level of immigration distress; 91.1% had moderate distress; and 2.5% had minor distress. Higher mean scores were found for the loss, novelty and language accommodation subscales of the Demand of Immigration specific Distress scale. Participant’s (r = 0.321, p < 0.01) and spouse’s (r = 0.375, p < 0.01) unemployment, and more children (r = 0.129, p < 0.05) led to greater immigration distress. Length of residency in Taiwan (r = 0.576, p < 0.001) was an effective predictor of immigration distress. It indicated that the participants who had stayed fewer years in Taiwan had a higher level of immigrant distress. Health care professionals need to be aware that the female newcomers in transnational marriages are highly susceptible to immigration distress. The study suggests that healthcare professionals need to provide a comprehensive assessment of immigration distress to detect health problems early and administer culturally appropriate healthcare for immigrant women in transnational marriages.

A free weekly iron-folic acid supplementation and regular deworming program is associated with improved hemoglobin and iron status indicators in Vietnamese women

Background Anemia due to iron deficiency is recognized as one of the major nutritional deficiencies in women and children in developing countries. Daily iron supplementation for pregnant women is recommended in many countries although there are few reports of these programs working efficiently or effectively. Weekly iron-folic acid supplementation (WIFS) and regular deworming treatment is recommended for non-pregnant women living in areas with high rates of anemia. Following a baseline survey to assess the prevalence of anemia, iron deficiency and soil transmitted helminth infections, we implemented a program to make WIFS and regular deworming treatment freely and universally available for all women of reproductive age in two districts of a province in northern Vietnam over a 12 month period. The impact of the program at the population level was assessed in terms of: i) change in mean hemoglobin and iron status indicators, and ii) change in the prevalence of anemia, iron deficiency and hookworm infections. Method Distribution of WIFS and deworming were integrated with routine health services and made available to 52,000 women. Demographic data and blood and stool samples were collected in baseline, and three and 12-month post-implementation surveys using a population-based, stratified multi-stage cluster sampling design. Results The mean Hb increased by 9.6 g/L (95% CI, 5.7, 13.5, p < 0.001) during the study period. Anemia (Hb<120 g/L) was present in 131/349 (37.5%, 95% CI 31.3, 44.8) subjects at baseline, and in 70/363 (19.3%, 95% CI 14.0, 24.6) after twelve months. Iron deficiency reduced from 75/329 (22.8%, 95% CI 16.9, 28.6) to 33/353 (9.3%, 95% CI 5.7, 13.0) by the 12-mnth survey, and hookworm infection from 279/366 (76.2%,, 95% CI 68.6, 83.8) to 66/287 (23.0%, 95% CI 17.5, 28.5) over the same period. Conclusion A free, universal WIFS program with regular deworming was associated with reduced prevalence and severity of anemia, iron deficiency and ho

Pathways to employment for migrants and refugees? The case of social enterprise

This paper examines the use of social enterprise – that is, not for personal profit businesses that have a strong social purpose- to support training and employment pathways for migrants and refugees facing multiple forms of exclusion. Drawing on an evaluation of a program that supports seven social enterprises in the Australian state of Victoria, the study finds that social enterprise affords unique local opportunities for economic and social participation for the program’s participants. Nevertheless, there are limits to the impacts of programs that mediate transitions within an increasingly flexible labour market without redressing the broader social determinants of labour market segmentation.

What explains the association between socioeconomic status and depression among Vietnamese adults?

Background Depression is a major public health problem worldwide and is currently ranked second to heart disease for years lost due to disability. For many decades, international research has found that depressive symptoms occur more frequently among low socioeconomic (SES) individuals than their more-advantaged peers. However, the reasons as to why those of low socioeconomic groups suffer more depressive symptoms are not well understood. Studies investigating the prevalence of depression and its association with SES emanate largely from developed countries, with little research among developing countries. In particular, there is a serious dearth of research on depression and no investigation of its association with SES in Vietnam. The aims of the research presented in this Thesis are to: estimate the prevalence of depressive symptoms among Vietnamese adults, examine the nature and extent of the association between SES and depression and to elucidate causal pathways linking SES to depressive symptoms Methods The research was conducted between September 2008 and November 2009 in Hue city in central Vietnam and used a combination of qualitative (in-depth interviews) and quantitative (survey) data collection methods. The qualitative study contributed to the development of the theoretical model and to the refinement of culturally-appropriate data collection instruments for the quantitative study. The main survey comprised a cross-sectional population–based survey with randomised cluster sampling. A sample of 1976 respondents aged between 25-55 years from ten randomly-selected residential zones (quarters) of Hue city completed the questionnaire (response rate 95.5%). Measures SES was classified using three indicators: education, occupation and income. The Center for Epidemiologic Studies-Depression (CES-D) scale was used to measure depressive symptoms (range0-51, mean=11.0, SD=8.5). Three cut-off points for the CES-D scores were applied: ‘at risk for clinical depression’ (16 or above), ‘depressive symptoms’ (above 21) and ‘depression’ (above 25). Six psychosocial indicators: life time trauma, chronic stress, recent life events, social support, self esteem, and mastery were hypothesized to mediate the association between SES and depressive symptoms. Analyses The prevalence of depressive symptoms were analysed using bivariate analyses. The multivariable analytic phase comprised of ordinary least squares regression, in accordance with Baron and Kenny’s three-step framework for mediation modeling. All analyses were adjusted for a range of confounders, including age, marital status, smoking, drinking and chronic diseases and the mediation models were stratified by gender. Results Among these Vietnamese adults, 24.3% were at or above the cut-off for being ‘at risk for clinical depression’, 11.9% were classified as having depressive symptoms and 6.8% were categorised as having depression. SES was inversely related to depressive symptoms: the least educated those with low occupational status or with the lowest incomes reported more depressive symptoms. Socioeconomicallydisadvantaged individuals were more likely to report experiencing stress (life time trauma, chronic stress or recent life events), perceived less social support and reported fewer personal resources (self esteem and mastery) than their moreadvantaged counterparts. These psychosocial resources were all significantly associated with depressive symptoms independent of SES. Each psychosocial factor showed a significant mediating effect on the association between SES and depressive symptoms. This was found for all measures of SES, and for males and females. In particular, personal resources (mastery, self esteem) and chronic stress accounted for a substantial proportion of the variation in depressive symptoms between socioeconomic groups. Social support and recent life events contributed modestly to socioeconomic differences in depressive symptoms, whereas lifetime trauma contributed the least to these inequalities. Conclusion This is the first known study in Vietnam or any developing country to systematically examine the extent to which psychosocial factors mediate the relationship between SES and depression. The study contributes new evidence regarding the burden of depression in Vietnam. The findings have practical relevance for advocacy, for mental health promotion and health-care services, and point to the need for programs that focus on building a sense of personal mastery and self esteem. More broadly, the work presented in this Thesis contributes to the international scientific literature on the social determinants of depression.

An action research approach for the professional development of Vietnamese nurse educators

Nurse education in Viet Nam is undergoing substantial reform. In order to facilitate the change, in 2007 the Viet Nam Nurses Association formed a collaborative partnership with the School of Nursing and Midwifery at an Australia university. This collaboration gave rise to the Viet Nam Nursing Capacity Building Project under the leadership of Professor Genevieve Gray, funded by the Atlantic Philanthropies. The new four year competency based nursing curriculum frame is expected to be implemented in September 2011 following approval by the Viet Nam Ministry of Education. The focus of this paper is the Teaching Fellowships Program, an initiative of the Viet Nam Nursing Capacity Building Project, developed to help meet the challenges associated with leading and dealing with the curriculum change. The paper explores the development of the program and justifies an action research approach, illuminates key issues, and briefly refers to changes to the next fellowship program.

A potential HIV epidemic among male street laborers in urban Vietnam

Background: Mass migration to Asian cities is a defining phenomenon of the present age, as hundreds of millions of people move from rural areas or between cities in search of economic prosperity. Although many do prosper, large numbers of people experience significant social disadvantage. This is especially the case among poorly educated, migrant unskilled unregistered male laborers who do much of the manual work throughout the cities. These men are at significant risk for many health problems, including HIV infection. However, to date there has been little research in developing countries to explain the determinants of this risk, and thereby to suggest feasible preventive strategies. Objectives and Methodology: Using combined qualitative and quantitative methods, the aim of this study was to explore the social contexts that affect health vulnerabilities and to develop conceptual models to predict risk behaviors for HIV [illicit drug use, unsafe sex, and non-testing for HIV] among male street laborers in Hanoi, Vietnam. Qualitative Research: Sixteen qualitative interviews revealed a complex variety of life experiences, beliefs and knowledge deficits that render these mostly poor and minimally educated men vulnerable to health problems including HIV infection. This study formed a conceptual model of numerous stressors related to migrants’ life experiences in urban space, including physical, financial and social factors. A wide range of coping strategies were adopted to deal with stressors – including problem-focused coping (PFC) and emotion-focused coping (EFC), pro-social and anti-social, active and passive. These men reported difficulty in coping with stressors because they had weak social networks and lacked support from formal systems. A second conceptual model emerged that highlighted equivalent influences of individual psychological factors, social integration, social barriers, and accessibility regarding drug use and sexual risk behavior. Psychological dimensions such as tedium, distress, fatalism and revenge, were important. There were strong effects of collective decision-making and fear of social isolation on shaping risk behaviors. These exploratory qualitative interviews helped to develop a culturally appropriate instrument for the quantitative survey and informed theoretical models of the factors that affect risk behaviors for HIV infection. Quantitative Research: The Information-Motivation-Behavioral Skills (IMB) model was adopted as the theoretical framework for a large-scale survey. It was modified to suit the contexts of these Vietnamese men. By doing a social mapping technique, 450 male street laborers were interviewed in Hanoi, Vietnam. The survey revealed that the risk of acquiring and transmitting HIV was high among these men. One in every 12 men reported homosexual or bisexual behavior. These men on average had 3 partners within the preceding year, and condom use was inconsistent. One third had had sex with commercial sex workers (CSW) and only 30% of them reported condom use; 17% used illicit drugs sometimes, with 66.7% of them frequently sharing injecting equipment with peers. Despite the risks, only 19.8% of men had been tested for HIV during the previous 12 months. These men have limited HIV knowledge and only moderate motivation and perceived behavioral skills for protective behavior. Although rural-to-urban migration was not associated with sexual risk behavior, three elements of the IMB model and depression associated with the process of mobility were significant determinants of sexual behavior. A modified model that incorporated IMB elements and psychosocial stress was found to be a better fit than the original IMB model alone in predicting protected sex behavior among the men. Men who were less psychologically and socially stressed, better informed and motivated for HIV prevention were more likely to demonstrate behavioral skills, and in turn were more likely to engage in safer sexual behavior. With regard to drug use, although the conventional model accounted for slightly less variance than the modified IMB model, data were of better fit for the conventional model. Multivariate analyses revealed that men who originated from urban areas, those who were homo- or bi-sexually identified and had better knowledge and skills for HIV prevention were more likely to access HIV testing, while men who had more sexual partners and those who did not use a condom for sex with CSW were least likely to take a test. The modified IMB model provided a better fit than the conventional model, as it explained a greater variance in HIV testing. Conclusions and Implications: This research helps to highlight a potential hidden HIV epidemic among street male, unskilled, unregistered laborers. This group has multiple vulnerabilities to HIV infection through both their partners and peers. However, most do not know their HIV status and have limited knowledge about preventing infection. This is the first application of a modified IMB model of risk behaviors for HIV such as drug use, condom use, and uptake of HIV testing to research with male street laborers in urban settings. The study demonstrated that while the extended IMB model had better fit than the conventional version in explaining the behaviors of safe sex and HIV testing, it was not so for drug use. The results provide interesting directions for future research and suggest ways to effectively design intervention strategies. The findings should shed light on culturally appropriate HIV preventive education and support programs for these men. As Vietnam has much in common with other developing countries in Southeast Asia, this research provides evidence for policy and practice that may be useful for public health systems in similar countries.

Design and delivery of a distance education programme : educating Vietnamese nurse academics from Australia

In 2008 a move away from medical staff providing nursing education in Vietnam saw the employment of many new nurse academics. To assist in the instruction of these novice academics and provide them with sound teaching and learning practice as well as curriculum design and implementation skills, Queensland University of Technology (QUT) successfully tendered an international grant. One of QUT’s initiatives in educating the Vietnamese academics was a distance learning programme. Developed specifically for Vietnamese nurse academics, the programme was designed for Australian based delivery to academics in Vietnam. This paper will present an overview of why four separate modules were utilised for the delivery of content (modules were delivered at a rate of one per semester). It will address bilingual online discussion boards which were used in each of the modules and the process of moderating these given comments were posted in both Vietnamese and English. It will describe how content was scaffolded across four modules and how the modules themselves modelled new teaching delivery strategies. Lastly, it will discuss the considerations of programme delivery given the logistics of an Australian based delivery. Feedback from the Vietnamese nurse academics across their involvement in the programme (and at the conclusion of their fourth and final module) has been overwhelmingly positive. Feedback suggests the programme has altered teaching and assessment approaches used by some Vietnamese nurse academics. Additionally, Vietnamese nurse academics are reporting that they are engaging more with the application of their content indicating a cultural shift in the approach taken in Vietnamese nurse education.