Author: Leung, Sik Yee
Title: Does colour still matter? A qualitative inquiry of health-seeking behaviours among South Asian ethnic minorities and its implications for health policy and practice in Hong Kong
Advisors: Ku, Ben (APSS)
Degree: DHSc
Year: 2021
Subject: South Asians -- Medical care -- China -- Hong Kong
Race discrimination -- China -- Hong Kong
Health services accessibility -- China -- Hong Kong
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: ix, 244 pages : color illustrations
Language: English
Abstract: My clinical experience in caring for ethnic minority patients made me ponder how they could live under the dark cloud of ethno-racial discrimination, where they were confronted by injustice in every aspect of their daily lives. Later my students' comment about having 'fear' to assist them aroused my curiosity further that I wanted to learn about ethnic minorities and their health-seeking behaviours. Besides, how and why the difference of their skin colours, races, cultures, and religious beliefs/practices could possibly subject them to a life of systemic discrimination and oppression from the host society, and that led to their suffering of various disadvantages, health inequalities and disparities. Even today, there are only limited empirical studies exploring Hong Kong ethnic minorities' health-seeking behaviours. Therefore, my doctoral study aims to examine their health-seeking behaviours – identifying factors that from their experiences could influence their health-seeking. I also have explored their cultural and health beliefs, perceived benefits and barriers, and cues to health-seeking behaviours that could affect their behaviours in finding healthcare support in Hong Kong.
The adoption of qualitative approach ensured my interviews were interactive and reflexive and allowed for ongoing evaluation. Twenty-five ethnic minorities were interviewed between 25th June and 23rd September 2019. These included eight Pakistanis, seven Nepalese, five Indians, four Bangladeshis and one Sri-Lankan. Among all the informants, sixteen of them were female, and nine were male, with ages ranging from 21 to 76. Two-thirds of them could communicate in English, but eight of them did not speak English and required an interpreter for the interviews.
Five themes influencing the informants' health-seeking behaviours were identified: macrostructural factors, predisposing factors, enabling factors, needs for healthcare, and acculturation. The macrostructural factors suggested that sinicisation (or mainlandisation) after the change of sovereignty in 1997 and the lack of a multicultural policy have socially excluded ethnic minorities, especially those in South Asian ethnic groups, from the dominant community. Hence, racial discrimination borne out of such factors adversely affected informants' health-seeking behaviours. Predisposing factors, including the power imbalance due to linguistic discrimination and health professionals' cultural insensitivity in the process of intercultural health communication, resulted in health inequalities and a denial of equal access to health services. Enabling factors suggested a push-pull effect in health-seeking among ethnic minorities. Push factors included long waiting time, administrative red-tape and intercultural communication, whereas pull factors included informal and formal social support, financial resources, the availability of an interpretation service, health equality and caring attitudes. These factors diverted informants to seek ethno-specific health information and treatment from local private clinics/hospitals, instead, they went for self-medication/treatment, spiritual healing, complementary and alternative medicine (CAM) and international healthcare providers, i.e. medical tourism. Informants' perceived health needs and self-rated health care needs factors directed them to their preferred health information and treatment. All four types of acculturation, i.e. integration, assimilation, separation, and marginalisation, have been clearly identified in the study; and to what extent my ethnic minority informants were influenced in how they sought health information and healthcare services.
Regarding the implications of my study, the findings revealed that the Hong Kong Special Administrative Region government, along with the Hospital Authority, has a duty of care and plays the main role in developing effective and sustainable healthcare policies, not just for the local Chinese but also its ethnic minority residents. Therefore, it is long overdue for the government to initiate a multicultural policy that improves intercultural health communication, promotes cultural sensitivity and diversity, makes ethno-specific care available and eliminates 'everyday racism'. Only then, can the cycle of cumulative disadvantages to ethnic minorities in health care be broken.
Rights: All rights reserved
Access: restricted access

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