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Chinese New Immigrant Mothers' Perception About Adult-Onset Non

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Chinese New Immigrant Mothers' Perception About Adult-Onset Non Health Promotion International, Vol. 30 No. 4 # The Author (2014). Published by Oxford University Press. All rights reserved. doi:10.1093/heapro/dau029 For Permissions, please email: [email protected] Advance Access published 19 May, 2014 Chinese new immigrant mothers’ perception about adult-onset non-communicable diseases prevention Downloaded from https://academic.oup.com/heapro/article/30/4/929/2355707 by guest on 29 September 2021 during childhood LINDA DONG LING WANG1, WENDY WING TAK LAM1, JOSEPH TSZ KEI WU2 and RICHARD FIELDING1* 1Health Behaviour Research Group, Division of Behavioural Health, School of Public Health, The University of Hong Kong, Hong Kong and 2Division of Epidemiology and Biostatistics, School of Public Health, The University of Hong Kong, Hong Kong *Corresponding author. E-mail: fi[email protected] SUMMARY Many non-communicable diseases (NCDs) are largely pre- as the primary causes of adult NCDs. Less than half of the ventable via behaviour change and healthy lifestyle, which participants recognized that parents had responsibility for may be best established during childhood. This study helping children establish healthy behaviours from an early sought insights into Chinese new immigrant mothers’ per- age to prevent diseases in later life. Most participants ceptions about adult-onset NCDs prevention during child- expressed helplessness about chronic diseases prevention hood. Twenty-three semi-structured interviews were carried due to lack of knowledge of prevention, being perceived as out with new immigrant mothers from mainland China beyond individual control. Many participants experienced who had at least one child aged 14 years or younger living barriers to seeking health information, the most common in Hong Kong. Interviews were audio taped, transcribed sources of health information being interpersonal conver- and analysed using a Grounded Theory approach. The sation and television. Participants’ everyday information present study identified three major themes: perceived practice was passive and generally lacked awareness regard- causes of adult NCDs, beliefs about NCDs prevention and ing early prevention of adult-onset NCDs. Updated under- everyday health information practices. Unhealthy lifestyle, standing of this issue has notable implications for future contaminated food and environment pollution were perceived health promotion interventions. Key words: non-communicable diseases; health perception; health information; qualitative methods INTRODUCTION mainly unhealthy diet, physical inactivity, smoking and harmful alcohol use (Gotay, 2005; WHO, Non-communicable diseases (NCDs) are the most 2011). Since these common risk factors are largely important causes of death in the twenty-first behavioural, WHO suggests NCDs prevention century, with over 60% of global mortality attrib- should be targeted at the level of family and com- utable to NCDs: cardiovascular diseases (CVDs), munity (WHO, 2011). Most of the health- cancers, chronic respiratory diseases and diabetes damaging behaviour determinants of adult-onset together accounting for around 80% of all NCDs NCDs are established early in life, with many deaths (WHO, 2011).However,asignificantfrac- modelled during childhood (Chen et al.,2001; tion of adult-onset NCDs are to a great extent Nadeau et al., 2011). Empirical studies evidence preventable via eliminating shared risk factors, the difficulty of altering well-ingrained health 929 930 L. D. L. Wang et al. behaviours among adults (Matarazzo, 1984), Hong Kong permanent residency), who are often whereas health behaviour change theoretically less well educated, employed in low skilled jobs could be easier and more effective for children or unemployed, with lower income, and tend to (Epstein et al., 1995). Clinical evidence suggests settle in lower socioeconomic districts of the city many diseases processes responsible for adult- (C&SD, 2012). Additionally, since most new onset NCDs, such as atherosclerosis, begin early immigrant adults are females, and in most house- in childhood (Feigin et al.,2009). Therefore, begin- holds mothers control or directly provide childcare ning primary prevention efforts for adult-onset (Keitel, 2000), therefore, our study focus on new NCDs during childhood and adolescence utilizes a immigrant mothers to seek insights into how critical window of opportunity to teach health pro- Chinese new immigrant mothers perceive adult Downloaded from https://academic.oup.com/heapro/article/30/4/929/2355707 by guest on 29 September 2021 moting behaviours. diseases prevention during childhood. However, previous studies regarding adult disease prevention during childhood have tended to focus on healthcare practitioners’ attitudes and METHOD practices as well as exploring possible interven- tions (Pratt and Tsitsika, 2007; Berenson et al., Study design and sample 2010). Surprisingly, few studies have explored parental perspectives; yet parents are among the The inclusion criteria for subject recruitment most powerful influences on children’s early specified ethnic Chinese women living in a Hong life and behaviour development (Hill and Kong household who migrated from mainland Trowbridge, 1998; Kiess et al., 2001). Existing China to Hong Kong no more than 7 years prior studies on parents’ perceptions of children’s to interview, and who had at least one child aged health issues which may contribute to future 14 years or younger. Using purposive sampling, adult diseases have overwhelmingly focused on participants were initially recruited through re- children’s weight and obesity, and how parents’ ferral from local NGOs and healthcare centres feed their children (Parry et al., 2008; Rietmeijer- providing support services for new immigrants. Mentink et al., 2013). To our knowledge, no Thereafter, snowballing to recruit friends and studies have examined parental perceptions and acquaintances of the original group was used to beliefs about adult NCDs prevention during recruit more potential participants who met spe- childhood. cific inclusion criteria. No new information from Hong Kong has one of the longest life expectan- three consecutive interviews signalled data satur- cies of any country or territory in the world ation and cessation of sampling. (LiveScience, 2012). Nevertheless, NCDs account for most of the disease burden in Hong Kong. In 2006, around 61% of registered deaths in Hong Data collection Kong were attributed to the four major prevent- Participants were invited to complete a semi- able NCDs (CHP, 2012). NCD risk factors, such structured one-to-one interview. Interview loca- as unhealthy diet, physical inactivity and tobacco tions were determined by participants where use, and the resulting disease clusters are more they felt would maintain their privacy and con- common among economically and socially disad- venience. All participants were informed about vantaged groups (CHP, 2012). As an immigrant the study purposes and procedures. After partici- society, the major source of Hong Kong popula- pants gave written informed consent, interviews tion growth is immigrants from mainland China. were conducted and audio taped. Interviews Other than a small number of professionally quali- began with participants being asked about their fied and investor migrants, the bulk of mainlander thoughts regarding adult-onset chronic diseases. immigrants (around 50 000 annually) comprise Respondents were encouraged to talk about One-way Permit (OWP) holders who are spouses their perceptions of causes of adult NCDs, pre- and dependent children from cross-border mar- ventive methods and then prevent adult diseases riages with Hong Kong permanent residents, the by action during childhood. Participants were majority of whom are of low socioeconomic status lead to describe health information sources they from Guangdong Province. (HAD & IMMD, used, and related practices they adopted were 2011). New immigrants hereafter refers to OWP also explored using questions and prompts. All holders who have been living in Hong Kong less interviews were conducted in Mandarin by a than 7 years (the minimum eligibility period for female interviewer (LDLW, a native Mandarin Preventing NCDs during childhood 931 speaker from mainland China). Each participant The present study identified three major themes: was offered a HK$100 (US$13) gift voucher mothers’ perceived causes of adult NCDs, beliefs for their participation on interview completion. about NCDs prevention and everyday health in- This study was approved by the Institutional formation practices. Figure 1 summarizes the rela- Review Board of the University of Hong Kong/ tionship of themes, categories and components. Hospital Authority Hong Kong West Cluster The precise numbers and proportion of partici- (HKU/HA HKW IRB). pants expressing each view are not provided as such data are not meaningful in a sample of this size. Illustrative quotes are provided to exemplify Data analysis categories and components. Downloaded from https://academic.oup.com/heapro/article/30/4/929/2355707 by guest on 29 September 2021 Interviews were transcribed verbatim in an ongoing process during the data collection and analysed using a Grounded Theory approach Theme 1: perceived causes of adult NCDs (Strauss and Corbin, 1998). The transcripts were As in Hong Kong, mainland China is also studied intensively to explore new or unantici- facing a rapidly growing challenge from NCDs pated issues raised by previous interviewees, (He et al.,2005). Cancers along attribute to around which
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