Della Maneze

Health reform: Is routinely collected electronic information fit for purpose?

Objective: Little has been reported about the completeness and accuracy of data in existing Australian clinical information systems. We examined the accuracy of the diagnoses of some chronic diseases in an ED information system (EDIS), a module of the NSW Health electronic medical record (EMR), and the consistency of the reports generated by the EMR.

Health-Seeking Behaviors of Filipino Migrants in Australia: The Influence of Persisting Acculturative Stress and Depression

This study examined the relationships among the constructs of acculturative stress, depression, English language use, health literacy, and social support and the influence of these factors on health-seeking behaviors of Filipino Australians. Using a self-administered questionnaire, 552 respondents were recruited from November 2010 to June 2011. Structural equation modelling was used to examine relationships. A direct and negative relationship between health-seeking behaviors and depression, and an indirect relationship with acculturative stress, was observed mediated through depression. Social support had an important moderating influence on these effects. Although there was an inverse relationship between age and English language usage and depression, age was positively related to health-seeking behavior. Despite their long duration of stay, Filipino Australian migrants continue to experience acculturative stress and depression leading to lower health-seeking behaviors. This study highlights the importance of screening for acculturative stress and depression in migrants and fostering social support.

Acculturative stress in Filipino migrants with functional English: implications for health promotion

The lack of host language proficiency is an important source of acculturative stress among new immigrants and is known to negatively impact on both physical and mental health. However, the acculturative stress and stressors of migrants from culturally and linguistically diverse (CALD) backgrounds with functional English language skills in Australia are less well-explored. Using the Filipino migrants as examplar, this paper reviews acculturative stress in three sub-population groups in this community: family migrants, Filipino spouses of Australian men and skilled, professional migrants. Despite English language ability, socioeconomic difficulties upon migration are a common source of acculturative stress. Intergenerational and cultural gaps within the family are conflict points that may cause depression and suicidal ideation. Changes in lifestyle and diet, incongruence of Western health practices with cultural beliefs may unfavourably affect health. Skilled and professional migrants experience stress due to underemployment, non-utilisation or non-recognition of qualifications obtained overseas. The health issues of CALD communities with functional English language skills are often overlooked in comparison with migrants lacking host population language skills. Taking sociocultural issues into consideration is pivotal when designing health promotion initiatives to meet the needs of Australian migrants with functional English language skills.

‘I have only little English’: language anxiety of Filipino migrants with chronic disease

ABSTRACT Objective: This study investigates communication challenges faced by Filipino patients with chronic diseases when engaging with healthcare professionals (HCPs). Design: Nine focus groups were conducted between November 2010 and June 2011. Results: Two main categories of themes were identified: patient-related and HCP-related factors. Patient-related factors included three subthemes: (1) lack of confidence in their English language abilities in clinical situations; (2) cultural attitudes; and (3) strategies used to improve communication. Older Filipinos with chronic disease were anxious about their lack of ability to explain their symptoms in English and were concerned that asking questions was conveying distrust in the HCPs. Most of the elderly simply nodded their head to indicate they understood even if they did not, for fear of being thought ‘stupid’. Many participants preferred Filipino GPs or have a relative interpret for them. Two subthemes were related to HCPs including (1) not being listened to and (2) assumptions of understanding. HCPs were thought to assume English language skills in Filipino patients and therefore were not careful about ensuring understanding. Conclusions: These findings highlighted the need for HCPs to be more aware of ‘grey areas’ in English-language proficiency and the cultural lens through which migrants understand health.

A descriptive study of kava use among Tongan men in Macarthur, Sydney South West

Objective: To describe the pattern of kava use among Tongan men in Macarthur.

Negotiating health and chronic illness in Filipino-Australians: a qualitative study with implications for health promotion

ABSTRACT Objective: In spite of the healthy immigrant effect, the prevalence of lifestyle-related chronic diseases among migrants is reported to approximate that of the host country with longer duration of stay. For example, higher rates of chronic diseases such as Type 2 diabetes and hypertension have been observed among Filipino migrants and these have been linked to acculturation. The aim of this study was to explore the experiences of Filipino-Australian migrants in managing their chronic health conditions in a Western host country. Design: This paper reports on qualitative findings of a mixed methods study that used an explanatory sequential design. Nine focus group discussions were undertaken with 58 Filipino-Australian migrants with chronic disease. Thematic analysis was undertaken using a five-stage general purpose thematic framework ensuring that themes closely identified key participants’ experiences. Results: Findings revealed that health benefits provided by the health system in Australia were considered advantageous. However, a lack of social and instrumental support compounded isolation and disempowerment, limiting self-management strategies for chronic illnesses. Cultural beliefs and practices influenced their knowledge, attitude to and management of chronic disease, which health service providers overlooked because of perceived acculturation and English language skills. Overall this study has clearly identified recognition of cultural beliefs, language needs and support as three core needs of Filipino-Australian migrants with the elderly the most vulnerable. Conclusion: This paper highlights that self-management of chronic disease among elderly Filipino immigrants may be adversely affected by host language difficulties, a lack of social support and cultural issues, impacting on access to services, health-seeking behaviours and participation in health promotion initiatives. Language, culture-specific health interventions and resources and enhancing social support are likely important strategies in promoting chronic disease self-management among the elderly. These interventions have the potential to empower and encourage individuals to take control and better manage their chronic disease.

The Influence of Health Literacy and Depression on Diabetes Self-Management: A Cross-Sectional Study

Despite an increasing focus on health literacy in the clinical setting and in the literature, there is still ongoing debate about its influence on diabetes self-management. The aim of the study was to examine the relationships of sociodemographic, clinical, and psychological factors on health literacy and diabetes self-management. A cross-sectional survey was undertaken on 224 patients with type 2 diabetes at two diabetes centres in Sydney, Australia. Findings showed that people with low health literacy were more likely to (a) have lower educational attainment; (b) be migrants; and (c) have depressed mood. Unexpectedly, those who met HbA1c threshold of good glucose control were more likely to have low health literacy. Predictors of low diabetes self-management included (a) younger age group (AOR: 2.58, 95% CI: 1.24–4.64); (b) having postsecondary education (AOR: 2.30, 95% CI: 1.05–5.01); (c) low knowledge of diabetes management (AOR: 2.29, 95% CI: 1.25–4.20); and (d) having depressed mood (AOR: 2.30, 95% CI: 1.30–4.06). The finding that depressed mood predicted both low health literacy and low diabetes self-management stresses the importance of screening for depression. Increasing peoples understanding of diabetes self-management and supporting those with depression are crucial to enhance participation in diabetes self-management.