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Perceptions of Medicinal and Medicated Food Use of Taiwanese

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Perceptions of Medicinal and Medicated Food Use of Taiwanese PERCEPTIONS OF MEDICINAL AND MEDICATED FOOD USE OF TAIWANESE IMMIGRANT FAMILIES IN THE US: A MULTI-METHOD EXPLORATORY STUDY A Dissertation Presented to the Faculty of the Graduate School of Cornell University in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy by Guan-Jen Sung August 2013 © 2013 Guan-Jen Sung PERCEPTIONS OF MEDICINAL AND MEDICATED FOOD USE OF TAIWANESE IMMIGRANT FAMILIES IN THE US: A MULTI-METHOD EXPLORATORY STUDY Guan-Jen Sung, Ph.D. Cornell University 2013 This study investigates the perceptions of medicinal and medicated food (MMF) use of Taiwanese immigrant families in the US. The background of use of food as medicine and for health promotion in Chinese history and in Taiwan and the situation of immigrants with transnational ties suggested that the Family Food Decision Making (FFDM) framework could be fruitfully applied along with the life course perspective (LCP) and expanded by the study. Informed by initial informant engagement, a preliminary framework informed design of the survey, including a questionnaire answered by 113 participants. The results were analyzed using descriptive statistics. Together with informant engagement of survey participants, it revealed a need to build trust relationships and social connections in interviewing. A constructivist grounded theory (CGT) approach to in-depth interviews was applied, with modifications for CGT analysis incorporating language translation. Twelve interviews were conducted. The building of trust and a pattern of interviewee behavior resulted in a distinctively egalitarian interview style. The study’s findings show that Taiwanese immigrants perceive the meaning of MMF in terms of taste and medicinal effectiveness and can practice amateur or connoisseur MMF usages. Parents are a major influence on transmission of MMF use; personality, religious food practices, and degrees of connection with Taiwanese Chinese medicine use also affect FFDM. Childhood training to accept MMF taste can further continuance of MMF use in later life. Recently increased transnational contacts contribute to bi-directional Taiwan/US influences on MMF sourcing and knowledge transmission. This has affected synergistically changing MMF environments in both places. These and other insights contribute to theorization about interactions of MMF meaning, family FDM dynamics, and human environmental influences, e.g., food traditions and systems and social relations. An MMF-expanded framework is developed from the FFDM Ecological System Framework. Methodological insights on building trust relationships and egalitarian influences on the interviewing mode inspired development of a dyadic dialogue method (DDM) that could aid FFDM Collaborative Engaged Research. The study also suggests three directions for future FFDM and MMF research: incorporating concern with FFDM efficacy, family- community MMF use collaborative engaged research, and exploration of Taiwan and US MMF systems. BIOGRAPHICAL SKETCH Guan-Jen Sung was born in Taichung, Taiwan. Her family moved to Taipei when she was 17 years old. She emigrated on her own to New Zealand after graduating from college and later moved to the US for graduate studies at Cornell University, while her parents and siblings gradually emigrated to Vancouver, Canada. During and after her undergraduate studies in botanical sciences at National Taiwan University, Sung was a research assistant in plant biotechnology at the Development Center for Biotechnology and in research on the origin of plant mitochondria at the Academia Sinica of Taiwan. She continued exploring her research interests at Otago University and Auckland Institute of Technology (now AUT University) in New Zealand. Sung pursued her advanced degrees in the US based on interest in connecting her plant sciences background across disciplines with human nutrition and Taiwanese Chinese medicine. She studied antioxidants in lotus embryotic germination for her master’s degree at Cornell. At that time, she was a teaching assistant in nutrition and an education assistant at Cornell Plantations. Before moving on to her doctoral research, she obtained city certification as an occupational health manager in Taipei, national certification as an English guide, and national certification as a dietitian in Taiwan. In her doctoral work at Cornell, Sung was trained as a counselor at Cornell’s EARS (Empathy, Assistance & Referral Service). Her doctoral research has focused on Taiwanese immigrants’ perceptions and decision making for medicinal and medicated food use. iii After graduation, Sung plans to move to the West Coast to be closer to her parents. Her training and research in community nutrition at Cornell as well as her interests will lead her to continue conducting research related to decision making for medicinal and medicated food use. iv To My Global Family Especially, My grandfather Sung Teng 宋藤 My father Sung Min-Lieh 宋敏烈 My mother Li Chiou-Jin 李秋金 Sharon L. McCoy and The Gillespies v ACKNOWLEDGMENTS I cannot give thanks enough to Dr. Ardyth Gillespie, my graduate committee chair, who expressed her faith in me, supported me in a multitude of ways, and inspired me to keep thinking bigger, deeper, and outside the box. Much of the delight of this research journey has depended on the solid foundation and leadership in appreciative inquiry which she provided. Special gratitude is also owed to the other members of my special committee. Their patience, encouragement, research guidance, and sharing of personal experiences on family food decision making broadened my understanding of food-life from both western and eastern approaches. Dr. Elaine Wethington brought me into engagement with human development and community research in health. Dr. Gilbert Gillespie deeply influenced my world view with his enthusiasm in his field of developmental sociology. He helped me think through issues of self-reflectiveness, family food decision making and food systems in sociological ways. Dr. Zhenglong Gu, an expert in research on nutritional genomics and ecology and evolution, was always able to point to core issues and questions and bring fresh perspectives for discussion in meetings with my whole committee. I learned much through him. During my doctoral work at Cornell, the College of Human Ecology gave me a one-year tuition award. The Family Food Decision Making Program, Division of Nutritional Sciences, provided me with graduate research assistantships for FFDM studies. These aids with financial support are deeply appreciated. I would also like to thank various others for contribution to the development of this study. Dr. Clair Forrest, whom I met in one of Dr. Wethington’s courses, provided a connection to my future chairperson; Dr. Jeffery Sobal’s teaching on theory in nutrition encouraged me to pursue vi theoretical development for my topic; and Dr. David Brown gave me valuable suggestions on this study in his course on community in sociology. Ms. Holly Archer assisted me with textual analysis and conducted a relevant methodological experiment with me. Drs. Francoise Vermeylen and Heim Bar provided guidance in statistics; Dr. Bar in particular encouraged and supported my applying analytical methods to allow concept theorizing. Much gratitude is also owed to Dr. Paul Shieh and his team from the Taiwanese American Association, Washington, DC, chapter and the 2008 Taiwanese American Conference/East Coast, who assisted me for informant engagement and the cruise survey. Students from the Family Food Decision Making Program research group between 2008 and 2011, particularly Charlene Chan and Lin-Lin Wang, generously offered help as informal informants. I want to express my deepest appreciation to all other anonymous informants and interviewees whose generous and sincere participation made this study possible. I am also grateful for Ms. Athena Kalandros’ assistance with grant application and proposal writing, and to Dr. Keith Hjortshoj, director of the Knight Institute of Writing Workshop, who helped guide my research writing. I appreciate the kind help of Dr. Chun Li from Ithaca College, in back-translating the survey material, and Ms. Fangfang Li, a Cornell Chinese program teacher, in checking translation of the survey material and interview guide. My sincere thanks are also owed to Ms. Sharon L. McCoy, an English language editor and tutor with Asian studies and anthropology background, who edited and proofread this dissertation. I am very grateful to Dr. Joseph Ho-Tyan Chen and his wife Mei-Hsi and family for their kindness and affection in treating me as a family member and sheltering me a spiritual home during my time in Ithaca for this study. I am also thankful to a number of Cornell nutrition graduate students: Drs. Ji-Yun Hwang and Tarun Biswas for their kind care and camaraderie and vii Drs. Angela Lu, Jian Yan, and Xinyin Jiang, David Sharp, Julia Felice, and Laura Smith for their good cheer. I cherish the caring concern from local Ithacans Dr. Dvorah Milner, Dr. Pierre Gremaud, Ms. Juila Yang and her mother Susan, Ms. Maureen Vivino, and Mr. Francis Facer. Dr. Mandy Esch accommodated me during my last year of study, and I was able to experience German culture and her kind friendship. I am especially grateful to Holly Archer and Sharon McCoy for their heartfelt care. In my anxiety of analyzing data and theorizing from them, Holly inspired my creativity. In my early despair of being able to embark on this research, Sharon selected the faculty members I should ask to be on my committee by computer search, without knowing them, and she was right. I also appreciate her inspiration by comparisons with her graduate research on Japanese kimono and tea ceremony. Finally, the greatest support behind this study comes from my father and mother, Min- Lieh Sung and Chiou-Jin Li, and my siblings Guan-Yi, Guan-Rung, and Michael Ming-Fung. Their love, understanding, and support grounded me so that I could continue my studies and research. Members of an immigration family themselves and together with all my relatives and family friends, they valued the importance of understanding other immigrant families in new environments and empathized with the challenges of this research.
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