New Perspectives on Chinese Immigrants’ Experiences under the New Zealand Healthcare System: A Qualitative Descriptive Study By Yi Wang A thesis submitted in partial fulfilment of the requirements of the degree of Master of Public Health School of Public Health and Psychosocial Studies Auckland University of Technology September 2011 i TABLE OF CONTENTS LIST OF TABLES ........................................................................................................... vi LIST OF FIGURES ........................................................................................................ vii ATTESTATION OF AUTHORSHIP .......................................................................... viii ACKNOWLEDGEMENTS ............................................................................................. ix ABSTRACT ....................................................................................................................... x PERSONAL STORY OF BEING A NEW IMMIGRANT .......................................... xi CHAPTER 1: INTRODUCTION .................................................................................... 1 Chinese Immigrants in New Zealand ............................................................................. 3 Chinese Immigrant Health and Accessing New Zealand Healthcare Services .............. 6 The Cultural Context ................................................................................................. 6 The Social Context ..................................................................................................... 8 Thesis Structure .............................................................................................................. 9 CHAPTER 2: LITERATURE REVIEW ...................................................................... 11 Who is involved and what is at stake – Immigration, Chinese, and Health ................. 12 Immigration ............................................................................................................. 12 Who is ‘Asian’ and the Chinese Identity.................................................................. 14 Health and Chinese Health ...................................................................................... 18 Chinese Health in New Zealand and World - Myth about the „Chinese Paradox‟ ...... 19 Finding the Root – Health and Accessing Healthcare Services in China ............... 20 Trying to Fit In – Chinese Health and Accessing Healthcare Services Overseas ... 23 Summary on Current Literature and Finding the Gap .................................................. 27 CHAPTER 3: RESEARCH METHODOLOGY AND METHODS .......................... 29 Methodological Choice for this Study .......................................................................... 29 Quantitative vs. Qualitative ..................................................................................... 29 Why Qualitative ....................................................................................................... 30 Why Descriptive ....................................................................................................... 31 Research Design Methods ............................................................................................ 34 Ethical Approval ...................................................................................................... 34 Overall Sampling Approach .................................................................................... 34 Participant Recruitment and Selection .................................................................... 36 ii Data collection – Survey .......................................................................................... 39 Data collection – Interview ..................................................................................... 40 Data Analysis ........................................................................................................... 43 Ethical Considerations .................................................................................................. 47 Do No Harm ............................................................................................................ 47 Voluntary Participation ........................................................................................... 48 Informed Consent..................................................................................................... 48 Avoid Deceit............................................................................................................. 48 Confidentiality ......................................................................................................... 48 Treaty of Waitangi ................................................................................................... 49 Trustworthiness of the Study and Promoting Rigour ................................................... 49 Credibility ................................................................................................................ 50 Dependability ........................................................................................................... 51 Transferability ......................................................................................................... 51 Confirmability .......................................................................................................... 52 Summary ...................................................................................................................... 52 CHAPTER 4: FINDINGS PART I – SURVEY RESULTS ........................................ 53 Introduction .................................................................................................................. 53 Demographics and General Information ...................................................................... 54 Gender ..................................................................................................................... 54 Age Group ................................................................................................................ 55 Marital Status .......................................................................................................... 55 Place of Birth ........................................................................................................... 56 Highest Education Qualification ............................................................................. 57 First and Other Language ....................................................................................... 57 Length of Residence in New Zealand....................................................................... 58 Personal Healthcare Information .................................................................................. 59 Questions 1 .............................................................................................................. 59 Question 1.1 ............................................................................................................. 60 Question 2 ................................................................................................................ 61 Question 2.1 ............................................................................................................. 63 Question 3 ................................................................................................................ 65 Question 4 ................................................................................................................ 66 Experiences in Receiving Healthcare Services ............................................................ 68 iii Question 5 ................................................................................................................ 69 Question 6 ................................................................................................................ 70 Question 7 ................................................................................................................ 71 Question 8 ................................................................................................................ 74 Question 9 ................................................................................................................ 76 Question 10 .............................................................................................................. 77 Summary ...................................................................................................................... 79 CHAPTER 5: FINDINGS PART II .............................................................................. 80 Introduction .................................................................................................................. 80 An Overview of Themes and Categories ..................................................................... 81 Primary Healthcare Services Delivery ......................................................................... 82 Primary: Language and Location ........................................................................... 83 Primary: Time Matters ............................................................................................ 84 Primary: How Good Is Good? ................................................................................ 86 The Secondary Healthcare Services Delivery .............................................................. 88 Secondary: Getting