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Culture and Healthcare Toward Vietnamese Adults and Elderly of Greater Springfield, Massachusetts

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Culture and Healthcare Toward Vietnamese Adults and Elderly of Greater Springfield, Massachusetts University of Massachusetts Amherst ScholarWorks@UMass Amherst Doctoral Dissertations 1896 - February 2014 1-1-2004 Culture and healthcare toward Vietnamese adults and elderly of Greater Springfield, Massachusetts. Duong Van Chu University of Massachusetts Amherst Follow this and additional works at: https://scholarworks.umass.edu/dissertations_1 Recommended Citation Chu, Duong Van, "Culture and healthcare toward Vietnamese adults and elderly of Greater Springfield, Massachusetts." (2004). Doctoral Dissertations 1896 - February 2014. 5511. https://scholarworks.umass.edu/dissertations_1/5511 This Open Access Dissertation is brought to you for free and open access by ScholarWorks@UMass Amherst. It has been accepted for inclusion in Doctoral Dissertations 1896 - February 2014 by an authorized administrator of ScholarWorks@UMass Amherst. For more information, please contact [email protected]. CULTURE AND HEALTHCARE TOWARD VIETNAMESE ADULTS AND ELDERLY OF GREATER SPRINGFIELD, MASSACHUSETTS A Dissertation Presented by DUONG VAN CHU Submitted to the Graduate School of the University of Massachusetts Amherst in partial fulfillment Of the requirements for the degree of DOCTOR OF EDUCATION September 2004 School of Education © Copyright by Duong V, Chu 2004 All Rights Reserved CULTURE AND HEALTHCARE TOWARD VIETNAMESE ADULTS AND ELDERLY OF GREATER SPRINGFIELD, MASSACHUSETTS A Dissertation Presented By DUONG VAN CHU Approved as to style and content by: David Buchanan, Member DEDICATION For my loving wife, Son, and my three wonderful children: Trong, Hanh, and MyDzung. You have always been my number one supporters and bring richness and meaning to my life. And, for my deceased mother. Although she was illiterate, she devoted her entire life to her three sons, and encouraged them to reach for an education. Her spirit will remains always within my soul ACKNOWLEDGEMENTS Ever since I was a child, I dreamt of achieving something that would be of service to others, especially my fellow Vietnamese countrymen. I have often shared my dream with many people. With the completion of this dissertation, I feel like I have accomplished my childhood dream. Thus, I am deeply grateful to the many individuals who were supportive and devoted to the long process of completing this dissertation. First, I would like to acknowledge the Vietnamese individuals who took part in my research. From them, I was able to collect information efficiently and expand my research. Their faithful cooperation has contributed numerously in accomplishing this dissertation. I am also thankful to my relatives and fnends in my community as well, for their encouragement and support. Very special thanks to my committee members: Dr. Robert Miltz, Dr. David Buchanan, and Dr. Sally Habana-Hafher, who have offered their valuable time and energy, and have continuously encouraged me to advance. I am especially grateful to Dr. David Buchanan, who has been my supporter and adviser ever since I first began this project. Not forgetting to mention Dr. Magda Ahmed, from the Massachusetts Department of Public Health, who provided me with many insights and opportunities in writing this dissertation. Thank you. Last but not least, I must confess that this dissertation would never have been completed without the support, encouragement, and understanding of my wife and three children. They have been an important source of comfort and motivation for me. V ABSTRACT CULTURE AND HEALTH CARE TOWARD VIETNAMESE ADULTS AND ELDERLY OF THE GREATER SPRINGFIELD, MASSACHUSETTS SEPTEMBER 2004 DUONG V. CHU, B.A., SAIGON UNIVERSITY M.A., UNIVERSITY OF MASSACHUSETTS AMHERST Ed. D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Professor Robert Miltz The relationship of culture and healthcare plays an important role in the success of health care access for everyone. In recent decades, the United States has opened its door to welcome not only refugees and immigrants from Europe, but also from other countries all over the world. Coming to the United States, these ethnic groups must overcome many problems to adjust to the American healthcare system. Meanwhile, American health providers not only misunderstand their refugees and immigrant clients’ culture, but also want them to conform to the requirement of purely biomedical treatment. The result is that access to healthcare for immigrant groups in the United States is likely to be difficult because of significant cultural differences between the clients and healthcare provider. This research used in depth-interviews, participant observations, and a case study to explore the interaction between culture and healthcare for Vietnamese refugee and immigrant adults and elderly living in the Greater Springfield, Massachusetts area; the VI I level of their involvement in the American healthcare and in traditional healthcare; the extent of integration of American healthcare and traditional healthcare; the obstacles they face in accessing and using American healthcare; and the importance of health education in successful healthcare access. Theories of acculturation, such as Models of Acculturation (Padilla, 1980) and Health Care System Model (Kleinman, 1978a) were used to process the study data to determine the extent of the influence of culture on the effectiveness of healthcare. Finally, based on data analysis, I explain how Vietnamese refugee and immigrant adults and elderly acculturate to the American healthcare system, and make recommendations for improving healthcare for them, as well as for other ethnic groups throughout America. Vll TABLE OF CONTENTS Page ACKNOWLEDEMENTS.. ABSTRACT. vi LIST OF TABLES.xii LIST OF FIGURES.xiii CHAPTER 1. INTRODUCTION.1 Statement of the Problem. 1 Purpose of the Study.4 The Researcher.5 Significance of the Study.5 Research Questions.6 Definition of Terms.8 n. LfTERATURE REVIEW.10 Theoretical Framework.10 Model of Acculturation Theory.11 Behavioral Model of Health Utilization.13 Healthcare System Model.15 Popular Sector.16 Professional Sector.17 Folk Sector. 17 Vietnamese in America and Cultural Adaptation and Acculturation..18 Waves of Refugees.19 Adjustment and Assimilation.20 Language Barrier.20 Family Values.21 Economics.22 Education.22 Health Problems 23 Vlll Smoking.23 Tuberculosis.24 Mental Health.24 Hepatitis B.25 Vietnamese and the American Healthcare System.,25 Discrimination.26 No Health Insurance.26 Under-Utilization of Healthcare Services.27 Family Values.28 Health Education.28 Vietnamese and Traditional Health Culture.30 Southern Medicine (Thuoc nam).31 Northern Medicine (Thuoc bac).32 Traditional Healthcare.32 “Hot” and “Cold” Theories.32 “Wind” (Phong).33 Religious Beliefs.34 Buddhism.34 Confucism.34 Taoism.35 Catholicism.35 Healthcare Practices.35 Coining (Cao gio).35 Pinching (Bat gio).36 Cupping (Giac hoi).36 Burning (Dot). 36 White Tape (Cao gian).36 Herbal Stream (Xong).37 Traditional Healthcare Usage. Vietnamese Community in Greater Springfield. Vietnamese in Greater Springfield and Acculturation.40 Health Problems. Adjustment and Acculturation..41 IX ni. METHODOLOGY 43 Research Design./♦S Sample..43 Data Collection.45 In-dept Interview.,45 Participatory Observations.46 Data Analysis..47 Validity and Reliability.48 Limitations.49 IV. RESULTS AND ANALYSIS.50 Respondents’ Biographical Background.51 Elementary School Level..51 Junior and High School Level.51 College Level.52 Overview of Healthcare Access in Vietnam Before 1995.54 Western Healthcare in Vietnam..55 Healthcare Strategy and Illness Prevention.56 Health Management.58 Traditional Healthcare..60 Herbal Medicine for Self-Treatment.62 Animal Medicines.65 Vietnamese Adults and Elderly in Greater Spripgfield Participating in American Healthcare.67 Vietnamese and American Healthcare.68 Primary Care Doctor.70 Doctor Visits.71 Behavior of the Doctor.76 Healthcare Treatment.79 Self-Treatment and Self-Adjustment.80 Visiting a Doctor for Serious Illness.-82 Discharging Medicines if the Symptoms Disappear.85 X Disease Prevention. ^86 Vietnamese Disease Prevention.,87 Prevention and Vaccination.89 Participation in Tradition^ Healthcare...91 Traditional Healthcare Concept.92 Traditional Healthcare Practices.96 Herbal Medicine for Self-Care Treatment.^00 Animal Medicine.i03 Traditional Health Medicine Resources.105 Vietnamese and Access Problems in American Healthcare.Ill Making an Appointment.J11 Language and Transportation Barriers.112 Time and Health Insurance Limitation.,115 How Could the American Healthcare System be Better Integrated into Vietnamese Traditional Healthcare?.118 American Healthcare and Alternative Medicine.123 Diet for Health Improvement.124 American Alternative Healthcare Practices.125 The Role of Health Education in Access to Healthcare.128 Health Education for Vietnamese.130 Education for American Health Providers.133 Education for Community Health Workers and Health Educators.137 Education for the Policy Makers.138 V. CONCLUSIONS AND RECOMMENDATIONS.139 Conclusions.139 Recommendations.146 APPENDICES A INTERVIEW QUESTIONAIRE (in English).148 B LETTER OF CONSENT.155 C PARTICIPATORY OBSERVATIONS.157 BIBLIOGRAPHY.159 XI LIST OF TABLES Table Page 1. Demographics of the Sample.44 2. Doctor’s Visits by Sample Group.73 3. American Doctor’s Behavior Towards the Sample Group.79 4. Health Treatment of Vietnamese Adults and Elderly.82 5. Use of Preventive Testing and Vaccination by the Sample Group.88 6. Traditional Health Practices Among the Sample Group.100 7. Use of Herbal, Chinese or Eastern Medicine by the Sample Group.103 Xll LIST OF FIGURES
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